“My Body is a Ticking Time Bomb”: Associations of Body Mindsets with Psychological Distress in People with Chronic Kidney Disease

“My Body is a Ticking Time Bomb”: Associations of Body Mindsets with Psychological Distress in People with Chronic Kidney Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “My Body is a Ticking Time Bomb”: Associations of Body Mindsets with Psychological Distress in People with Chronic Kidney Disease Emily J Dowling, Tripti Singh, Joseph Chilcot, Alia J Crum, Lauren C Heathcote This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6464039/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jun, 2025 Read the published version in International Journal of Behavioral Medicine → Version 1 posted You are reading this latest preprint version Abstract Background This study investigated the association between body mindsets-established, but mutable beliefs a person holds about their body-with psychological distress in people with chronic kidney disease (CKD). Methods A cross-sectional, mixed methods survey was conducted in people with CKD at a range of disease stages and treatment modalities. Participants completed the Patient Health Questionnaire-4 (PHQ-4) to capture distress, the Body Mindset Inventory (BMI), and qualitative free-text responses elaborating on their mindsets. Hierarchical regression models explored associations of body mindsets with psychological distress, controlling for demographic variables, treatment modalities, and comorbidities. Results Two hundred and thirty-two adults with CKD (62% female) completed the survey; 27.6% were receiving dialysis and 34.7% had received a kidney transplant. Those who more strongly endorsed the mindset that their Body is an Adversary reported greater psychological distress, while those who more strongly endorsed the mindsets that their Body is Capable or Responsive reported less psychological distress. Together, all three mindsets explained 12% unique variance in psychological distress, even after accounting for demographic factors, treatment modalities, and comorbidities. Mixed-methods analyses illustrated the range of body mindsets in people with CKD, with some describing their body as “A ticking time bomb” and others stating “My body is a fighter just like me. My body is amazing.” Conclusion Mindsets about the body are significantly associated with psychological distress in people with CKD. These cross-sectional data provide a foundation for future longitudinal and interventional studies on the relationship between mindsets and distress outcomes in people living with CKD. Chronic Kidney Disease Body Mindsets Core Beliefs Psychological Distress Depression Figures Figure 1 Figure 2 Figure 3 Introduction Living with chronic kidney disease (CKD) presents a cascade of physical challenges, including high symptom burden, the demands of long-term dialysis, and the possibility of kidney transplantation ( 1 ). Over 98% of people with CKD also experience at least one medical comorbidity such as hypertension or diabetes mellitus, conditions that themselves pose significant burden due to their complex disease trajectories and challenging symptom management ( 2 , 3 ). The way individuals navigate these challenges—particularly the degree of psychological distress they experience—may be influenced by the fundamental beliefs they hold about their bodies. Are their bodies resilient enough to endure intensive treatments? Does a diagnosis of CKD signify that their bodies are failing, and will continue to fail them? These beliefs have been termed ‘body mindsets’ – defined as core assumptions about what the body is, how it functions, and what it represents. Body mindsets (e.g., ‘My Body is Capable’ or ‘My Body is an Adversary’) are core beliefs or assumptions about the nature of one’s body that orient individuals toward specific ways of interpreting and responding to bodily experiences ( 4 , 5 ). While body mindsets share conceptual overlap with related constructs like body image, they are broader in their inclusion of beliefs about how the body functions rather than merely how it looks. Body mindsets are subjective interpretations of the body’s capability or functionality and are therefore distinct from the objective nature of one’s body – for example, a person can have severe CKD and still view their body as generally ‘Capable’ of handling the disease and its treatment. Likewise, seeing their body persist and recover following treatments and surgeries may lead them to view their body as highly ‘Responsive’. In this way, mindsets are not necessarily true or false; rather, they are selective viewpoints that change how people feel, perceive, and act and therefore can be more or less useful depending on the context ( 6 , 7 ). Body mindsets are not static; they are influenced by personal experiences, cultural narratives, and medical interactions, making them a potentially modifiable target for intervention ( 4 – 6 , 8 ). Psychological distress is a significant and pervasive issue among individuals with CKD, who face disproportionate burdens of physical and emotional strain compared to the general population ( 9 , 10 ). Studies indicate that up to 58% of people with CKD report clinically significant symptoms of anxiety or depression, which are linked to poorer treatment adherence, higher mortality rates, and reduced quality of life ( 11 – 13 ). While demographic and clinical factors such as age, comorbidities, and disease stage contribute to psychological distress, these variables do not fully explain the variability observed in patient outcomes ( 14 ). Emerging evidence suggests that cognitive and emotional frameworks, including body mindsets, may play a critical role in shaping how patients interpret and cope with the challenges of chronic illnesses such as CKD ( 7 , 8 ). Research investigating body mindsets has utilised The Body Mindset Inventory (BMI), which was designed to capture three a priori body mindsets proposed to be relevant in the context of health and illness – the mindsets that my Body is an Adversary, my Body is Capable, and my Body is Responsive ( 4 ). In one study of childhood cancer survivors, those survivors who more strongly endorsed the mindset that their Body is an Adversary reported worse pain, greater bodily threat monitoring behaviours, and greater fear of cancer recurrence, while those who more strongly endorsed the mindset that their Body is Responsive engaged in less bodily threat monitoring behaviours ( 15 ). In another study, adolescents with chronic pain who more strongly endorsed the mindset that their Body is an Adversary reported greater pain-related fear and catastrophising while those more strongly endorsing the Body is Capable and Body is Responsive mindsets reported less pain catastrophising (Dowling et al., 2025; under review). Across cross-sectional studies, body mindsets have been shown to be associated with unique statistical variance in health outcomes beyond demographic factors, medical factors, and objective markers of disease ( 6 , 15 ). Moreover, a digital intervention for recently diagnosed cancer patients which instilled the mindset that my Body is Capable significantly improved symptom distress and health-related quality of life during cancer treatment compared to a treatment-as-usual control group (Zion et al., 2023). Changes in the Body is Capable mindset mediated the intervention effect. Body mindsets may provide an additional target for understanding and intervening on psychological distress in people with CKD. Yet, body mindsets have not been investigated in people with CKD. This study had three aims, employing a mixed methods approach to assess body mindsets in adults with CKD and to examine the association of body mindsets with psychological distress. Firstly, we aimed to measure the three different body mindsets from the BMI in a sample of adults with CKD and to further illustrate these mindsets using an open-text response question where patients were asked to expand on their body mindsets in their own words. Secondly, we aimed to explore associations of body mindsets with demographic factors, treatment modalities, comorbidities, and psychological distress. Thirdly, we aimed to explore whether body mindsets were associated with psychological distress beyond demographic factors, treatment modalities, and comorbidities. We hypothesised that a more unhelpful body mindset (my Body is an Adversary) would be associated with poorer psychological distress, while more helpful body mindsets (my Body is Capable and my Body is Responsive) would be associated with less psychological distress, even while controlling for demographic factors, treatment modalities, and comorbidities. Materials and Methods Design This study uses a cross-sectional convergent parallel mixed-methods approach, whereby two types of data (quantitative and qualitative) are collected, analysed, and then integrated for interpretation. An intra-method technique ( 16 ) was used in which data were collected using a single method, in this case an online survey, to produce quantitative (closed-ended questions) and qualitative (free-text response questions) data. Participants Individuals were eligible if they were over the age of 18, living in the United Kingdom at the time of completing the survey, and receiving treatment for chronic kidney disease (CKD). This included people with CKD stages 3b+, people on dialysis or with a kidney transplant, or people receiving supportive care. Individuals were not eligible to take part if informed consent was not provided and if they did not indicate that they could comprehend and respond to questions in English (see Fig. 1 for the participant flow chart). Recruitment Ethical approval was obtained through the Research Ethics Management Application System in the United Kingdom (HR-22/23-34712). Adults receiving treatment for CKD were recruited through CKD charities who circulated a study flyer and link, and through posting the study flyer and link on CKD-related Facebook and Twitter groups. The study flyer included a link to the online participant information sheet and consent form via Qualtrics ( https://www.qualtrics.com ) where individuals could read further information about the study, complete screening questions, provide informed consent, and then complete the survey. Participants were not financially reimbursed for completing the survey. The survey was accessible from 27th February 2023 through 16th February 2024. Measures Quantitative Data Demographic Factors, Treatment Modalities, and Comorbidities Participants self-reported demographic information including age, sex, and ethnicity. The primary cause of kidney disease, current treatments, and previous treatments for kidney disease were collected through self-report using items utilised in previous research ( 17 ). Participants self-reported currently received treatments at the time of the study which are referred to as ‘treatment modalities’ throughout this paper. Comorbidities were captured using the self-report comorbidity questionnaire ( 18 ). The self-report comorbidity questionnaire was initially developed in a sample of inpatients from medical and surgical care units ( 19 ), developed based on commonly used comorbidity instruments. Sridharen and colleagues (2014) adapted this measure for patients with end-stage renal disease by utilising eight of the twelve medical conditions most relevant for patients on haemodialysis. Participants were asked three questions including whether they have the condition, whether they are receiving treatment for it, and whether it limits their daily activities. Each positive response was given a score of one, therefore a maximum score of three could be obtained for each condition. Participants were instructed to leave the question blank if they did not have the condition, had not received treatment for the condition, or if the condition did not limit their activities for each item respectively. Scores across questions for each condition were summed to generate a composite self-reported comorbidity score. Body Mindsets The Body Mindset Inventory (BMI) comprises 10 items assessing three body mindsets in the context of chronic illness ( 4 ): Body is Capable (3 items; ω = .82), Body is Responsive (3 items; ω = .81), and Body is an Adversary (4 items; ω = .83). The BMI is designed such that the name of the illness being studied (in this case, CKD) is included in the questionnaire items, for example “having chronic kidney disease means my body has betrayed me”. For all items, individuals responded on a 6-point Likert scale (6 = strongly agree, 1 = strongly disagree) and a mean score is created for each subscale separately. Higher mean scores on each subscale indicate greater endorsement of that mindset. As each mindset is measured with separate items, participants could endorse agreement with multiple mindsets. As this measure has not been utilised in a CKD population previously, a Confirmatory Factor Analysis was conducted to confirm the three-factor structure of the BMI in the sample. Psychological Distress The Patient Health Questionnaire 4-item (PHQ-4) ( 20 ) combines the two screening items from the Patient Health Questionnaire 2-item (PHQ-2) and the General Anxiety Disorder 2-item (GAD-2) to measure core signs of depression and anxiety, respectively. The PHQ-4 (ω = .91) is a brief measure that reduces patient survey burden and excludes items that assess somatic symptoms that may confound the measurement of distress with assessment of medical comorbidities. For each item, participants answer how often they were bothered by the problem in the last two weeks on a 4-point Likert scale (0 = not at all, 3 = nearly every day), and items are summed to create a total score. Aligning with its use in health research, we refer to the total composite score as psychological distress, wherein higher scores reflect more psychological distress ( 21 , 22 ). Qualitative Data After completing the BMI, participants were asked: “ In your own words, please describe how you think and feel about your body. We are interested not in how you think your body looks, but how your body works and doesn't work, how your body functions, and how your body supports you in everyday life.” Analyses Quantitative data were analysed and visualised using Statistical Packages for the Social Sciences (SPSS) version 29 0.1.0 ( 23 ) and R version 4.2.2. A Confirmatory Factor Analysis (CFA) was conducted to confirm the factor structure of the BMI given its novel use in CKD. Pearson correlations examined univariate associations of continuous variables including body mindsets with age, comorbidities, and psychological distress. Independent sample t -tests examined associations of continuous variables with sex. Analyses of Variance (ANOVA) explored associations of continuous variables with treatment modalities which comprised five groups: advanced kidney care, in-centre haemodialysis, home dialysis (including peritoneal dialysis and continuous ambulatory peritoneal dialysis), kidney transplant, and supportive/conservative care. Significance levels were set at p < .05, two-tailed. Hierarchical linear regression analyses examined unique variance in psychological distress explained by body mindsets adjusting for age, sex, treatment modalities, and comorbidities. In Step 1, age and sex were entered into the model, followed by treatment modalities and comorbidities in Step 2 (dummy coded, with dialysis recipients as the reference category). In Steps 3a, 3b and 3c, each body mindset—Body is Capable, Body is Responsive, and Body is an Adversary—were added individually. In Step 4, all three body mindsets were added simultaneously to assess the total variance in psychological distress associated with body mindsets beyond demographics factors, treatment modalities, and comorbidities. All variables were added using the enter method. The qualitative freely-generated responses were analysed using a two-staged process using Miro, an online tool for brainstorming and mapping ideas on digital boards ( 24 ). The primary coder (EJD) first familiarised herself with the data through reading and re-reading the responses, while recursively coding data in Miro. In the first stage, coding was conducted deductively by using the three body mindset subscales from the BMI as the overarching codes. The BMI considers body mindset subscales that are worded to reflect one dimension of each mindset (e.g. my Body is Capable), with no reverse-scored items. Mindsets can however be understood across a two-dimensional spectrum; using the Capable mindset example, people may fall anywhere along the spectrum of strongly endorsing the mindset that their Body is Capable to strongly endorsing the mindset that their Body is Incapable. Therefore, qualitative data were purposely coded across a two-dimensional spectrum for each mindset. In addition, qualitative data were further coded inductively to identify possible novel body mindsets not captured by the BMI. Coding was discussed iteratively with two additional researchers with expertise in qualitative data analyses for health psychology research (LCH) and the psychological science of mindsets (AJC). Integration of Quantitative and Qualitative Data Integration of quantitative BMI data and qualitative free-response data was conducted via joint display using a matrix to generate meta-inferences. The primary aim of data integration was complementarity, in which the quantitative BMI data were illustrated with the qualitative free-response data to enhance understanding and extend the scope of inquiry ( 25 , 26 ). To do this, a joint display was created that juxtaposed data to illustrate how the BMI subscales across a two-dimensional spectrum mapped onto the qualitative free-response quotes. A row was added to illustrate potentially novel body mindsets reported by patients that appeared distinct to those in the current BMI. A meta-inference was provided for complementarity, elaboration, and illustration across the two types of data. Specifically, meta-inferences enabled examination of how quantitative and qualitative data complemented or enriched one another (complementarity), how qualitative data provided examples of the BMI subscales (illustration), and how the qualitative data provided a more detailed understanding of the BMI subscale scores (elaboration) ( 26 ). Quantitative Results Sample Characteristics Of the 292 participants that commenced the survey, 232 completed or partially completed the study measures (see Fig. 1 for participant flowchart). For those who responded to at least 80% of items across measures (excluding the comorbidities scale, which contained true zeros), prorating was applied to compute values for missing items. Prorated scores were then used to calculate total scores. Participants who responded to less than 80% of items across measures were excluded from analyses. Sensitivity analyses were performed to assess how the results varied depending on the missing data techniques used. Multiple imputation was performed on a separate dataset in SPSS version 29 0.1.0 ( 23 ) using the automatic imputation model with 10 iterations. Analyses were replicated across different missing data techniques. Results from the pooled multiple imputed datasets can be found in the Supplementary files. Most participants were aged 46–55, self-identified as White (91.5%), and female (61.9%). The most common current treatment reported was ‘kidney transplant’ (34.7%; see Table 1 for medical and demographic information). Table 1 Medical and demographic information of the sample. Variable N (%) Age (years) 18–25 4 (1.7) 26–35 23 (9.7) 36–45 31 (13.1) 46–55 59 ( 25 ) 56–65 58 (24.6) 66–75 47 (19.9) 76–85 13 (5.5) 86+ 1 (0.4) Gender Male 85 ( 36 ) Female 146 (61.9) Other 1 (0.4) Non-Binary 1 (0.4) Ethnicity Asian or Asian British 11 (4.7) Mixed or Multiple Ethnic Groups 4 (1.7) White 216 (91.5) Black, Clack British, Caribbean, or African 1 (0.4) Other Ethnic Group 2 (0.8) Primary Cause of Kidney Disease Diabetes 19 (8.1) Glomerulonephritis 28 (11.9) Polycystic Kidney Disease 48 (20.3) Lupus or Vasculitis 5 (2.1) Hypertension 12 (5.1) Other 83 (35.2) I do not know 40 (16.9) Current Treatment Modalities Advanced Kidney Care/ Low Clearance Kidney Care 46 (19.5) In-Centre Haemodialysis 36 (15.3) Home Haemodialysis 11 (4.7) Peritoneal Dialysis 16 (6.8) Continuous Ambulatory Peritoneal Dialysis 2 (0.8) Kidney Transplant 82 (34.7) Supportive/ Conservative Care 39 (16.5) Previous Treatment In-centre Haemodialysis 72 (30.5) Home Haemodialysis 21 (8.9) Peritoneal Dialysis 49 (20.8) Continuous Ambulatory Peritoneal Dialysis 26 ( 11 ) Kidney Transplant 73 (30.79) Not Applicable / None of the above 108 (45.8) Comorbidities Has Condition Receives Treatment Limits Activities Heart disease such as angina or poor heart function 42 (17.8) 29 (12.3) 15 (6.4) Previous Heart Attack 18 (7.6) 15 (6.4) 7 ( 3 ) Diabetes 35 (14.8) 31 (13.1) 11(4.7) Cancer 20 (8.5) 16 (6.8) 9 (3.8) Lung Disease 6 (2.5) 6 (2.5) 8 (3.4) Arthritis 39 (16.5) 18 (7.6) 25 (10.6) Confirmatory Factor Analysis for the Body Mindset Inventory Given that the BMI had not previously been used in a CKD sample, a CFA was conducted in Mplus to confirm the three-factor structure of the BMI. In CFA, a non-significant chi-squared is desired and standard model fit indices were evaluated including; the Comparative Fit Index (CFI) and Tucker-Lewis index (TLI), with values exceeding .90 indicating good fit, although ≥ .95 is preferred ( 27 ). Additionally, the root mean square error of approximation (RMSEA) was evaluated with a value of < .08 considered to demonstrate approximate fit. The model had a good fit as determined by the CFI (.94), TLI (.92), and RMSEA (.003) indices. The significant chi-squared indicated a poor model fit (χ 2 = 87.82, df = 32, p = .00), although chi-squared values are largely influenced by sample size. All items revealed factor loadings exceeding .60 indicating that items loaded appropriately onto their respective factors. Overall, results of the CFA suggest that the three-factor structure of the BMI holds in the sample of people with CKD. Standardised factor loadings are presented in Fig. 2 . Body Mindset Descriptive Results As illustrated in Fig. 3 , scores on each body mindset subscale were widely distributed reflecting substantial individual variability in the mindsets that adults with CKD hold about their bodies. The median endorsement for each mindset fell in the “somewhat disagree” range for the Body is Capable mindset ( Mdn = 3.0, IQR = 1.34) and the “somewhat agree” to “somewhat disagree” range for both the Body is Responsive ( Mdn = 3.3, IQR = 1.67) and Body is an Adversary mindsets ( Mdn = 3.3, IQR = 1.75). As shown in Table 2 , the Body is Capable and Body is Responsive mindsets were positively and moderately associated with one another. The Body is an Adversary mindset was negatively and moderately associated with the Body is Responsive mindset and the Body is Capable mindset. To quantify endorsement of each mindset in terms of agreement and disagreement, those who scored 1–3 on each subscale were considered to disagree with endorsing the mindset, whereas those who scored > 3–6 on each subscale were considered to agree with endorsing the mindset. Overall, 45.3% ( n = 105) of participants agreed with the mindset that my Body is Capable, 54.5% ( n = 126) of participants agreed with the mindset that my Body is Responsive, and 55.0% ( n = 126) of participants agreed with the mindset that my Body is an Adversary. Body Mindsets Across Demographic Factors, Treatment Modalities, and Comorbidities As seen in Table 2 , endorsement of body mindsets were not different across sex or age. Results from ANOVAs indicated that there was a significant relationship between current treatment modalities and endorsement of the mindsets that my Body is Capable and Body is an Adversary. Bonferroni post-hoc tests indicated that those receiving advanced kidney care ( M = 2.58) were less likely to endorse the mindset that my Body is Capable compared to home dialysis recipients ( M = 3.31; mean difference = − .73) and kidney transplant recipients ( M = 3.16, mean difference = − .58). Additionally, advanced kidney care recipients ( M = 3.90) were more likely to endorse the mindset that my Body is an Adversary compared to kidney transplant recipients ( M = 2.83; mean difference = 1.06). In-centre dialysis recipients ( M = 3.72) were more likely to endorse the mindset that my Body is an Adversary compared to kidney transplant recipients ( M = 2.83; mean difference = .88). Reporting a greater number of comorbidities was associated with greater endorsement of the Body is an Adversary mindset and less endorsement of the Body is Capable and Body is Responsive mindsets (Table 2 ). Table 2 Univariate associations of body mindsets with demographic variables, treatment modalities, and comorbidities. 1. 2. 3. 4. 5. 6. 7. 8. 1. Body is an Adversary 1 2. Body is Capable − .316** 1 3. Body is Responsive − .324** .582** 1 4. Psychological Distress .340** − .314** − .302** 1 5. Comorbidities .169* − .209** − .230** .167* 1 6. Treatment Modalities (F) 7.99*** 3.00* 2.37 1.52 2.60* 1 7. Age − .024 .057 − .016 − .281*** .279*** 2.29 1 8. Sex ( t ) 1.11 1.08 1.67 − .30 1.62 - 3.52*** 1 Note. F -values from Analyses of Variance (ANOVA) present associations of treatment modalities and t -values present associations with sex, * p < .05, ** p < .01, *** p < .001. Body Mindsets and Psychological Distress In correlational analyses, greater endorsement of the Body is an Adversary mindset was associated with higher psychological distress, whereas greater endorsement of the Body is Capable and Body is Responsive mindsets were associated with lower psychological distress. In hierarchical linear regression analyses and as shown in Table 3 , all three body mindsets were significantly associated with psychological distress while controlling for demographic factors, treatment modalities, and comorbidities. Greater endorsement of the Body is an Adversary mindset was associated with more psychological distress while greater endorsement of the Body is Capable and Body is Responsive mindsets were associated with less psychological distress. When all three mindsets were entered into the same regression model (Step 4), the Body is an Adversary mindset remained significantly associated with psychological distress. Together, the three body mindsets contributed 12% of the variance in psychological distress and all variables in the model contributed 24% of the variance psychological distress. Table 3 Unique associations of body mindsets with psychological distress beyond demographic factors, treatment modalities, and comorbidities. Step 1 Step 2 Step 3a Step 3b Step 3c Step 4 Demographic Factors Sex .03 (-1.28, .84) − .02 (-1.18, .92) − .03 (-1.24, .78) − .06 (-1.45, 1.32) .01 (-.90, 1.09) − .02 (1.11, .88) Age − .28*** (-1.08, − .38) − .36*** (-1.28, − .56) − .34*** (-1.21, − .51) − .35*** (-1.25, − .56) − .33*** (-1.19, − .50) − .32*** (-1.17, − .50) Medical-Related Factors Transplant − .01(-1.29, 1.16) − .001 (-1.20, 1.18) − .01 (-1.21, 1.14) .08 (-.59, 1.79) .06 (-.68, .1.66) Advanced Care .02 (-1.25, 1.62) − .01 (-1.53, .1.28) − .01 (-1.46, 1.32) − .12 (-1.53, 1.20) − .04 (-1.70, 1.01) Supportive Care .001 (-1.50, 1.51) − .001 (-1.45, 1.43) − .02 (-1.56, 1.23) − .02 (-1.22, 1.64) − .01 (-1.35, 1.47) Comorbidities .27*** (.18, .57) .22* (.11, .50) .21* (.10, .48) .22*** (.13, .60) .18* (.07, .45) Body Mindsets Body is Capable − .23*** (-1.27, − .36) − .08 (-.83, .25) Body is Responsive − .27*** (-1.33, − .46) − .14 (.99, .05) Body is Adversary .33*** (.62, 1.44) .26*** (.39, 1.25) Adj R 2 .07 .12 .17 .18 .21 .24 F Statistic 8.66*** 5.69*** 8.75*** 7.72*** 8.95*** 8.17*** * p < .05, ** p < .01, *** p < .001. Dummy coded treatment variables present differences in advanced kidney care, supportive/conservative care and transplant recipients between dialysis recipients. Qualitative Results Overall, 195 participants responded to the free-text response question. These qualitative data supported and further illustrated the mindsets captured in the BMI as well as providing insight into the opposite end of each mindset dimension (e.g., illustrating the opposite end of the mindset that the Body is an Adversary, specifically the Body is an Ally) while offering insights into potential novel mindsets not captured by the BMI. Meta-inferences from integrating quantitative and qualitative data are summarised in the table below. Table 4 Meta-Inference table integrating qualitative and quantitative body mindset data. Body Mindset Qualitative Quote and Quantitative BMI Score Meta-Inference from integrating Qualitative and Quantitative Data Body is an Adversary / Body is an Ally ‘Adversary’ exemplars (BMI Adversary scores 5.25-6.00) “It is like living with a ticking time bomb and you have no idea what will detonate it and when it will blow up”. (Female aged 56–65) “It just feels like whatever the surgeons/renal team try to do to help me, my body finds a way to object”. (Female aged 46–55) “My body is useless and has betrayed me”. (Female aged 26–35) ‘Ally’ exemplars (BMI Adversary scores 1.00-1.50) “I will work with my body to deal with it as well as I can – we have a good relationship”. (Female aged 26–35) “Up until this point my body has taken care of me. Now it’s my turn to take care of it”. ( Female aged 36–45) There were several illustrative examples of the mindset ‘My Body is an Adversary’ in people with CKD. Participants described their body as unpredictable, with symptoms arising unexpectedly and a constant sense of waiting for something to go wrong. Some felt their body actively worked against them, rejecting medical interventions. Participants who held this mindset described their body as an enemy, including examples of betrayal and deception. On the opposite side of this dimension, participants who scored low on this BMI subscale qualitatively reported viewing their body as an Ally. They described that their body had taken care of them and supported them throughout their CKD journey. They described a body that was working with them, rather than against them. In return, participants described a motivation to care of their body. Body is Capable / Body is Incapable ‘Capable’ exemplars (BMI Capable scores 3.67–5.67) “I am content that my body works within the boundaries set for it”. (Male aged 66–76 “I think my body is pretty strong. It deals with a lot after all”. (Female aged 36–45) ‘Incapable’ exemplars (BMI Capable scores 2.67) “My body clearly doesn’t work”. (Male aged 26–35) “My body is unable to handle some things that were perfectly normal before: it is no longer as strong as it was...It is a strange feeling, knowing my body needs help and no longer functions as well as it used to”. (Female aged 36–45) Participant quotes illustrated how they viewed their bodies as Capable or Incapable in the context of CKD. Some participants described that they felt their body was doing its best to manage CKD, despite the challenges and boundaries set by the condition. Others described believing that their body is able to cope with CKD and support them in their valued life goals. On the opposite side of this dimension, participants described that their body was incapable, unable to rise to the occasion when needed, or overcome challenges from CKD treatment. Similarly, some described that the limited support provided by their body in achieving their life goals was insufficient. Body is Responsive / Body is not Responsive ‘Responsive / not Responsive’ exemplars “I am proud of how my body has recovered and healed from illness, operations and surgeries, it has been very resilient”. (Female aged 26–35, BMI Body is Responsive score: 1.33). “My body has a high tolerance in general, it heals well after operations”. (Female, aged 36–45, BMI Body is Responsive score: 3.67). “My body takes longer to heal after illness or injury”. (Female, aged 56–65, BMI Body is Responsive score: 3.67). “I've noticed an increase in healing times over wounds and general infections”. (Male aged 26–35, BMI Body is Responsive score: 4.33). Participants wrote several descriptions of their body’s capabilities to heal and recover within the context of CKD, aligning with the content on the BMI Body is Responsive subscale. However, unlike the other mindsets illustrated above, qualitative responses did not closely match quantitative responses on this BMI subscale. For example, one participant who scored low (1.33 out of 6) on the Body is Responsive BMI subscale wrote that that they were proud of how their body had recovered and healed and described their body as ‘resilient’. As another example, two participants with equivalent scores of 3.67 out of 6 on the Body is Responsive BMI subscale described their bodies in quite different ways, with one describing their body as healing well after operations and the other describing their body as taking longer to heal after illness or injury. Lastly, one participant who scored relatively high on the BMI Responsive subscale (4.33 out of 6) described that their body took longer to heal from wounds and general infections. Quantitative and qualitative data integration indicate that the body’s capacity to heal and recover is relevant for people with CKD but that the BMI Responsive subscale may not adequately capture the full variation of beliefs in this context. Potential New Mindsets Not Captured in the BMI Body is Amazing Body is Dysfunctional “My body is brilliant. Despite immunosuppression I rarely get ill, I am generally fitter, happier and healthier than I was pre transplant… My body is a remarkable thing, the third kidney just quietly cracks on with doing the job the other two couldn't!“. (Male aged 36–45) “I think my body is amazing, to have been through two transplants at 35, to have stable function, and amazingly given the massive cocktail of drugs it has been subjected to over 35 years, have nothing else wrong with it”. ( Female, aged 26–35) “My body keeps me alive and has survived so much! My body is a fighter just like me. My body is amazing”. (Female, aged 36–45) “If asked I’d think my body is amazing that I survived at all…I am truly grateful for this bag of bones for keeping me going all this time. It’s pretty remarkable”. (Female, aged 46–55) “My broken, useless body”. (Male, aged 66–75) “To me my body is dying from the inside out”. (Male, aged 66–75) “I really feel like my body is breaking down”. (Female, aged 56–65) Inductive coding of qualitative data indicated possible novel mindsets that were not adequately captured in the BMI. First, several participants described that their body was “amazing,” “brilliant,” and “extraordinary”. While these participants often scored high on the Body is Capable BMI subscale, their qualitative data went beyond descriptions of the body merely being capable, indicating a possibly distinct ‘Body is Amazing’ mindset. Quotes coded to reflect this mindset were not oriented around comparison of one’s body to others, but rather an expression of awe at the body’s functioning. Participants describing their body as a fighter that continues to function astonishingly well, even with CKD, expressed gratitude for their body. Second, other participants described their body as “dysfunctional” and “broken”. While participants describing their bodies in this way scored relatively high on the Body is an Adversary mindset, these qualitative codes did not reflect the active adversarial qualities of the body but rather a more passive brokenness and uselessness. Discussion This mixed methods study explored body mindsets and their associations with psychological distress in people with CKD. Findings revealed wide variation in the extent to which individuals endorsed mindsets such as my Body is Capable, my Body is Responsive, and my Body is an Adversary. These mindsets independently correlated with psychological distress, even after adjusting for demographic factors, treatment modalities, and comorbidities. Since mindsets are relatively easy to assess, incorporating mindset assessments into clinical practice may offer practical benefits for patient care. Future research should examine whether targeting these mindsets through clinical and psychological interventions can improve distress and outcomes in CKD supportive care. Psychological distress is the most common psychological issue in CKD, associated with faster kidney function decline, increased hospitalisations, and a higher number of comorbidities ( 11 ). Despite its prevalence and impact, psychological distress is not routinely assessed or managed in CKD care ( 28 ). As distress levels tend to rise with disease progression ( 29 ), effective management is essential to slow deterioration and reduce the need for invasive treatments ( 30 ). Identifying risk and resilience factors for distress can inform interventions to help patients cope with CKD and improve outcomes ( 31 , 32 ). Although our data are cross-sectional, findings suggest that body mindsets act as both risk and resilience factors for psychological distress in CKD. Specifically, stronger endorsement of the Body is an Adversary mindset was associated with higher distress, indicating its potential role in poorer CKD management and health outcomes. In contrast, endorsing the Body is Capable and Body is Responsive mindsets was associated with lower psychological distress, suggesting they may foster resilience. These associations remained significant after controlling for demographics, treatment modalities, and comorbidities. Our findings align with broader research on illness beliefs in CKD, particularly perceptions of controllability (e.g., “There is little that can be done to improve my illness”) and coherence (e.g., “I don’t understand my illness”), both linked to greater distress ( 33 , 34 ). Moreover, a meta-analysis identified cognitive appraisals as key associates of psychological distress, emphasising the role of illness and body perceptions in its development and maintenance ( 35 ). This study builds on existing literature by highlighting the importance of functional body beliefs – specifically, whether individuals see their bodies as capable of responding to and tolerating treatments like dialysis. Given CKD’s progressive nature and ongoing challenges, future research should explore whether identifying unhelpful body mindsets and shifting towards more helpful ones can foster resilience, empower patients in disease management, and reduce distress. Our secondary aim was to explore associations between body mindsets and demographic factors, treatment modalities, and comorbidities. We observed no significant relationships between body mindsets and age or sex, aligning with prior research in cancer patients and survivors ( 4 , 15 ). However, in adolescents (aged 8–17) with chronic pain, body mindsets varied by age and sex (Dowling et al 2025; under review). Regarding comorbidities, individuals with CKD who had more comorbidities more strongly endorsed the Body is an Adversary mindset and less strongly endorsed the Body is Capable and Responsive mindsets. Differences also emerged across treatment modalities. Advanced kidney care recipients were less likely to endorse the Body is Capable mindset and more likely to view their Body as an Adversary compared to kidney transplant recipients. Since advanced kidney care focuses on managing disease progression and preparing for kidney replacement therapy, it might highlight bodily limitations rather than potential. In contrast, a kidney transplant can symbolise renewed function, fostering hope and a sense of capability, potentially shifting perceptions away from adversarial views of the body. Similarly, in-centre dialysis recipients were more likely to endorse the Body is an Adversary mindset compared to transplant recipients. The structured, externally controlled nature of in-centre dialysis, coupled with rigid treatment schedules, may amplify feelings of bodily betrayal or inadequacy. For many dialysis patients, particularly those ineligible for transplantation, the lack of a definitive treatment endpoint may reinforce perceptions of ongoing struggle and loss of autonomy. Additionally, the greater symptom burden and diurnal variations in well-being associated with haemodialysis can exacerbate frustration with the body ( 36 ). These findings suggest opportunities for interventions targeting body mindsets to enhance coping and quality of life in CKD treatment. For example, mindset interventions delivered after haemodialysis could help individuals reframe their experiences and cultivate a more adaptive perspective on bodily changes. Such interventions could emphasise resilience and the body’s capacity to adapt to treatment demands. Future research should assess the feasibility and efficacy of such approaches, particularly in addressing the unique psychological and physical stressors faced by in-centre dialysis patients. We asked people with CKD to describe their body mindsets using a free-text response, revealing alignment with predefined body mindsets in the BMI. Descriptions of the body as an unpredictable opponent reflected the Body is an Adversary mindset, while viewing the body as effectively managing CKD challenges aligned with the Body is Capable mindset. Similarly, perceiving the body as able to recover and heal corresponded to the Body is Responsive mindset. Notably, participants also expressed perspectives beyond these predefined mindsets. Some described their body as an ally that worked with them, representing the opposite end of the Body is an Adversary mindset spectrum. Others felt their body provided insufficient support in daily life, suggesting a Body is Incapable mindset. Interestingly, alignment between quantitative and qualitative data was weaker for the Body is Responsive mindset, indicating the need for further refinement of this BMI subscale in CKD. Additionally, qualitative responses suggested other mindsets not captured by the BMI, such as viewing the body as Dysfunctional or Amazing. Mindsets can be modified through psychologically wise interventions, which introduce helpful perspectives during periods of uncertainty to improve well-being, health, and behaviour ( 37 ). Brief, digital mindset interventions have shown promise in improving coping, symptom distress, and quality of life in cancer patients by targeting illness and body mindsets ( 5 ). The qualitative findings from this study suggest that people with CKD can view their body as ‘capable’, ‘resilient’, and ‘amazing’, offering valuable insights for development mindset interventions. Embedding real patient narratives can reinforce the plausibility of these mindsets. Additionally, acknowledging how CKD diagnosis and treatment can contribute to adversarial or broken body perceptions may help normalise, validate, and destigmatise these experiences – an essential first step toward mindset change. Brief digital storytelling interventions illustrating mindset shifts despite adversity could help individuals with CKD recognise their body mindsets, understand their impact, and develop skills to adopt more helpful body mindsets. Integrating such interventions into care at key moments, such as diagnosis dialysis initiation, could provide timely psychological support and improve health outcomes. Our study has several limitations. First, our sample were largely female and White. Since sex and gender differences are common in body image research, further exploration of body mindsets in men and racially diverse CKD populations is needed. Second, the cross-sectional design prevents causal conclusions – while body mindsets may influence psychological distress, distress could also reinforce certain body mindsets. Third, CKD’s progressive nature may shape these relationships over time, warranting longitudinal or interventional studies. Additionally, the qualitative free-text response was placed after the BMI items to illustrate quantitative findings. However, asking participants to generate their body mindsets beforehand might have revealed additional perspectives. In-depth qualitative interviews could also provide richer insights into the CKD-related body mindsets and the language used to express them. Lastly, online recruitment allowed us to reach participants beyond a single clinical site but may limit generalisability, particularly for individuals less engaged with online CKD communities. In conclusion, our findings indicate the diverse body mindsets of people with CKD, ranging from viewing the body as an adversary to recognising its resilience and strength. These mindsets were uniquely associated with psychological distress, independent of demographic factors, treatment modalities, and comorbidities. Future experimental research should explore whether shifting body mindsets in this population can help reduce psychological distress. Declarations Statement Regarding Informed Consent: Informed consent was obtained from all individual participants included in the study. Statement Regarding Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee, as described in the manuscript, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Conflict of Interest: The authors declare that they have no conflict of interest. Author Contribution TS led the ethical approval process and the initial phase of data collection, with contributions from JC and LCH.EJD contributed to data collection, conceptualised the study, conducted the analysis, and wrote the original draft.LCH and JC supervised the project and contributed to the study’s overall conceptualisation.AJC contributed to the study's conceptualisation and interpretation of findings.AJC, JC, and LCH reviewed and edited the manuscript. Acknowledgement We would like to thank the participants for taking part in the study and the following organisations for their support with recruitment for the project: Kidney Care UK, Kidney Research UK, National Kidney Federation, and the UK Kidney Association. References Mehrotra R, Davison SN, Farrington K, Flythe JE, Foo M, Madero M, et al. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney international. 2023;104(3):441-54. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney international. 2011;80(12):1258-70. Martini A, Ammirati A, Garcia C, Andrade C, Portela O, Cendoroglo MS, et al. Evaluation of quality of life, physical, and mental aspects in longevous patients with chronic kidney disease. International urology and nephrology. 2018;50:725-31. Zion SR. From Cancer to COVID-19: the Self-Fulfilling Effects of Illness Mindsets on Physical, Social, and Emotional Functioning: Stanford University; 2021. Zion SR, Schapira L, Berek JS, Spiegel D, Dweck CS, Crum AJ. Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psycho-Oncology. 2023;32(9):1433-42. Zeidman A, Benedict C, Zion SR, Fisher S, Tolby L, Kurian AW, et al. Association of illness mindsets with health-related quality of life in cancer survivors. Health Psychology. 2022;41(6):389. Crum A, Akinola M, Martin A, Fath S. The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, Stress, & Coping. 2017;30(4):379-95. Crum AJ, Salovey P, Achor S. Rethinking stress: the role of mindsets in determining the stress response. Journal of personality and social psychology. 2013;104(4):716. Palmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney International. 2013;84(1):179-91. Dos Santos PR, Mendonça CR, Hernandes JC, Borges CC, Barbosa MA, de Sousa Romeiro AM, et al. Pain in patients with chronic kidney disease undergoing hemodialysis: A systematic review. Pain Management Nursing. 2021;22(5):605-15. Tsai Y-C, Chiu Y-W, Hung C-C, Hwang S-J, Tsai J-C, Wang S-L, et al. Association of Symptoms of Depression With Progression of CKD. American Journal of Kidney Diseases. 2012;60(1):54-61. Alshelleh S, Alhouri A, Taifour A, Abu-Hussein B, Alwreikat F, Abdelghani M, et al. Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients. Scientific Reports. 2022;12(1):17627. Chilcot J, Guirguis A, Friedli K, Almond M, Day C, Da Silva-Gane M, et al. Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis. Annals of Behavioral Medicine. 2017;52(1):1-8. Hedayati S, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney International. 2012;81(3):247-55. Dowling EJ, Simons LE, Crum AJ, Spunt SL, Simon P, Webster SN, et al. Body mindsets are associated with pain and threat-related risk factors for pain in survivors of childhood cancer. The Journal of Pain. 2023. Johnson B, Turner LA. Data collection strategies in mixed methods research. Handbook of mixed methods in social and behavioral research. 2003;10(2):297-319. Chilcot J, Pearce CJ, Hall N, Rehman Z, Norton S, Griffiths S, et al. Depression and anxiety in people with kidney disease: understanding symptom variability, patient experience and preferences for mental health support. Journal of nephrology. 2025:1-12. Sridharan S, Berdeprado J, Vilar E, Roberts J, Farrington K. A self-report comorbidity questionnaire for haemodialysis patients. BMC Nephrology. 2014;15(1):134. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis Care & Research. 2003;49(2):156-63. Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics. 2009;50(6):613-21. Adzrago D, Walker TJ, Williams F. Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity. BMC Psychiatry. 2024;24(1):213. Kroenke K, Baye F, Lourens SG. Comparative validity and responsiveness of PHQ-ADS and other composite anxiety-depression measures. Journal of Affective Disorders. 2019;246:437-43. IBM C. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp; 2021. Lee LJ. Tools: MIRO Real-time board, visual collaborations and tools, easy screen sharing and presentation. 2019. Bryman A. Integrating quantitative and qualitative research: how is it done? Qualitative Research. 2006;6(1):97-113. Greene JC, Caracelli VJ, Graham WF. Toward a conceptual framework for mixed-method evaluation designs. Educational evaluation and policy analysis. 1989;11(3):255-74. Bentler PM. Comparative fit indexes in structural models. Psychological Bulletin. 1990;107(2):238-46. Hedayati SS, Finkelstein FO. Epidemiology, Diagnosis, and Management of Depression in Patients With CKD. American Journal of Kidney Diseases. 2009;54(4):741-52. Jansen DL, Heijmans MJ, Rijken M, Spreeuwenberg P, Grootendorst DC, Dekker FW, et al. Illness perceptions and treatment perceptions of patients with chronic kidney disease: different phases, different perceptions? Br J Health Psychol. 2013;18(2):244-62. Muscat P, Chilcot J, Weinman J, Hudson J. Exploring the relationship between illness perceptions and depression in patients with chronic kidney disease: A systematic literature review. Journal of Renal Care. 2018;44(3):174-85. Zalai D, Szeifert L, Novak M. Psychological Distress and Depression in Patients with Chronic Kidney Disease. Seminars in Dialysis. 2012;25(4):428-38. Tian X, Gao Q, Li G, Zou G, Liu C, Kong L, et al. Resilience is associated with low psychological distress in renal transplant recipients. General Hospital Psychiatry. 2016;39:86-90. Jansen DL, Grootendorst DC, Rijken M, Heijmans M, Kaptein AA, Boeschoten EW, et al. Pre-dialysis patients' perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study. BMC nephrology. 2010;11:1-10. Chilcot J. The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes. Semin Dial. 2012;25(1):59-64. Chan R, Steel Z, Brooks R, Heung T, Erlich J, Chow J, et al. Psychosocial risk and protective factors for depression in the dialysis population: A systematic review and meta-regression analysis. Journal of Psychosomatic Research. 2011;71(5):300-10. Kallem CJ, Alghwiri AA, Yabes J, Erickson S, Han Z, Roumelioti M-E, et al. Diurnal and Daily Symptom Variation in Patients with End Stage Kidney Disease: An Ecological Momentary Assessment Study. Clinical Journal of the American Society of Nephrology. 2024;19(10):1292-300. Walton GM, Crum AJ. Handbook of wise interventions: Guilford Publications; 2020. Additional Declarations No competing interests reported. Supplementary Files BodyMindsetsCKDSupplementarymaterialsMultipleimputationanalyses.docx Cite Share Download PDF Status: Published Journal Publication published 27 Jun, 2025 Read the published version in International Journal of Behavioral Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6464039","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":446626369,"identity":"ad6ec3c1-84bc-4b14-bcc2-337d7e2fb8ce","order_by":0,"name":"Emily J Dowling","email":"","orcid":"","institution":"King’s College London","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"J","lastName":"Dowling","suffix":""},{"id":446626371,"identity":"a7fbfe56-3f46-4c1e-b64f-819298b58e40","order_by":1,"name":"Tripti Singh","email":"","orcid":"","institution":"King’s College London","correspondingAuthor":false,"prefix":"","firstName":"Tripti","middleName":"","lastName":"Singh","suffix":""},{"id":446626372,"identity":"f5331e4b-3cc6-45d0-a626-b75fe0cc8656","order_by":2,"name":"Joseph Chilcot","email":"","orcid":"","institution":"King’s College London","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Chilcot","suffix":""},{"id":446626375,"identity":"1f866705-28ea-48ff-808d-ebc2d9ec8ac2","order_by":3,"name":"Alia J Crum","email":"","orcid":"","institution":"Stanford University","correspondingAuthor":false,"prefix":"","firstName":"Alia","middleName":"J","lastName":"Crum","suffix":""},{"id":446626377,"identity":"79a260f2-63b1-4a83-b8c4-70c58b9dd014","order_by":4,"name":"Lauren C Heathcote","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYBACPiidAMRsYBY/DwPjATCLB7sWNoQWZhDbgEGyh4GBRC0GZwhpYT9j9uHjDoY8fvbzxx78qPgjZ3zm8IMDDDV2QL0HsGvhyTGeOfMMQ7FkTzK7Yc8ZA2Ozs20GBxiOJTMYnG3A4bAcY2beNobEDQeS2aQZ2wwSt53nATqM7QCDwXkcDuN/Y8z8F6hl//nHYC31m/tBWv7h0SIBtIURZIsExJYEA94ehgOMbQdwO0ziWTFjb5tE4owbj80ke84YG844c8zgQGJfMo8kDu/z8ydvZvjZZpPY35/4TOJHhZw8f0/ywwcfvtnJ8Z1JwO4yCJBA4yfgjJVRMApGwSgYBcQAABzyWI9ZLstuAAAAAElFTkSuQmCC","orcid":"","institution":"King’s College London","correspondingAuthor":true,"prefix":"","firstName":"Lauren","middleName":"C","lastName":"Heathcote","suffix":""}],"badges":[],"createdAt":"2025-04-16 13:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6464039/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6464039/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12529-025-10379-6","type":"published","date":"2025-06-27T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82166131,"identity":"30ded02d-655c-4f51-869e-05d48a362fc4","added_by":"auto","created_at":"2025-05-07 09:11:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39983,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant flow chart.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6464039/v1/4deb2df6cf53283b0ceb6007.jpg"},{"id":82167069,"identity":"338123c5-72dc-497a-a523-2c264c3f2633","added_by":"auto","created_at":"2025-05-07 09:19:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":68730,"visible":true,"origin":"","legend":"\u003cp\u003eConfirmatory Factor Analysis of the Body Mindset Inventory.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6464039/v1/191d608240491a0e22e911d8.jpg"},{"id":82166133,"identity":"d84f88ab-ceb5-43e5-904b-1f5d9253f3db","added_by":"auto","created_at":"2025-05-07 09:11:53","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":51486,"visible":true,"origin":"","legend":"\u003cp\u003eViolin plots combined with box plots presenting the distribution and central tendencies of body mindset subscale scores in patients with chronic kidney disease.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6464039/v1/8d5d9e6d991fc835be85b1b4.jpg"},{"id":85686184,"identity":"fde66f2d-5aee-4ab3-98a9-7d583caf9aab","added_by":"auto","created_at":"2025-06-30 16:04:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2142721,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6464039/v1/8e28a616-2d36-4252-982b-cedbfbb02696.pdf"},{"id":82166132,"identity":"86235de1-da33-4178-9795-7942b8afb850","added_by":"auto","created_at":"2025-05-07 09:11:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":25485,"visible":true,"origin":"","legend":"","description":"","filename":"BodyMindsetsCKDSupplementarymaterialsMultipleimputationanalyses.docx","url":"https://assets-eu.researchsquare.com/files/rs-6464039/v1/bb47ee4b144a42c1fdef516d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"“My Body is a Ticking Time Bomb”: Associations of Body Mindsets with Psychological Distress in People with Chronic Kidney Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLiving with chronic kidney disease (CKD) presents a cascade of physical challenges, including high symptom burden, the demands of long-term dialysis, and the possibility of kidney transplantation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Over 98% of people with CKD also experience at least one medical comorbidity such as hypertension or diabetes mellitus, conditions that themselves pose significant burden due to their complex disease trajectories and challenging symptom management (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The way individuals navigate these challenges\u0026mdash;particularly the degree of psychological distress they experience\u0026mdash;may be influenced by the fundamental beliefs they hold about their bodies. Are their bodies resilient enough to endure intensive treatments? Does a diagnosis of CKD signify that their bodies are failing, and will continue to fail them? These beliefs have been termed \u0026lsquo;body mindsets\u0026rsquo; \u0026ndash; defined as core assumptions about what the body is, how it functions, and what it represents.\u003c/p\u003e \u003cp\u003eBody mindsets (e.g., \u0026lsquo;My Body is Capable\u0026rsquo; or \u0026lsquo;My Body is an Adversary\u0026rsquo;) are core beliefs or assumptions about the nature of one\u0026rsquo;s body that orient individuals toward specific ways of interpreting and responding to bodily experiences (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). While body mindsets share conceptual overlap with related constructs like body image, they are broader in their inclusion of beliefs about how the body functions rather than merely how it looks. Body mindsets are subjective interpretations of the body\u0026rsquo;s capability or functionality and are therefore distinct from the objective nature of one\u0026rsquo;s body \u0026ndash; for example, a person can have severe CKD and still view their body as generally \u0026lsquo;Capable\u0026rsquo; of handling the disease and its treatment. Likewise, seeing their body persist and recover following treatments and surgeries may lead them to view their body as highly \u0026lsquo;Responsive\u0026rsquo;. In this way, mindsets are not necessarily true or false; rather, they are selective viewpoints that change how people feel, perceive, and act and therefore can be more or less useful depending on the context (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Body mindsets are not static; they are influenced by personal experiences, cultural narratives, and medical interactions, making them a potentially modifiable target for intervention (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychological distress is a significant and pervasive issue among individuals with CKD, who face disproportionate burdens of physical and emotional strain compared to the general population (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Studies indicate that up to 58% of people with CKD report clinically significant symptoms of anxiety or depression, which are linked to poorer treatment adherence, higher mortality rates, and reduced quality of life (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). While demographic and clinical factors such as age, comorbidities, and disease stage contribute to psychological distress, these variables do not fully explain the variability observed in patient outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Emerging evidence suggests that cognitive and emotional frameworks, including body mindsets, may play a critical role in shaping how patients interpret and cope with the challenges of chronic illnesses such as CKD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearch investigating body mindsets has utilised The Body Mindset Inventory (BMI), which was designed to capture three \u003cem\u003ea priori\u003c/em\u003e body mindsets proposed to be relevant in the context of health and illness \u0026ndash; the mindsets that my Body is an Adversary, my Body is Capable, and my Body is Responsive (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In one study of childhood cancer survivors, those survivors who more strongly endorsed the mindset that their Body is an Adversary reported worse pain, greater bodily threat monitoring behaviours, and greater fear of cancer recurrence, while those who more strongly endorsed the mindset that their Body is Responsive engaged in less bodily threat monitoring behaviours (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In another study, adolescents with chronic pain who more strongly endorsed the mindset that their Body is an Adversary reported greater pain-related fear and catastrophising while those more strongly endorsing the Body is Capable and Body is Responsive mindsets reported less pain catastrophising (Dowling et al., 2025; under review). Across cross-sectional studies, body mindsets have been shown to be associated with unique statistical variance in health outcomes beyond demographic factors, medical factors, and objective markers of disease (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, a digital intervention for recently diagnosed cancer patients which instilled the mindset that my Body is Capable significantly improved symptom distress and health-related quality of life during cancer treatment compared to a treatment-as-usual control group (Zion et al., 2023). Changes in the Body is Capable mindset mediated the intervention effect. Body mindsets may provide an additional target for understanding and intervening on psychological distress in people with CKD. Yet, body mindsets have not been investigated in people with CKD.\u003c/p\u003e \u003cp\u003eThis study had three aims, employing a mixed methods approach to assess body mindsets in adults with CKD and to examine the association of body mindsets with psychological distress. Firstly, we aimed to measure the three different body mindsets from the BMI in a sample of adults with CKD and to further illustrate these mindsets using an open-text response question where patients were asked to expand on their body mindsets in their own words. Secondly, we aimed to explore associations of body mindsets with demographic factors, treatment modalities, comorbidities, and psychological distress. Thirdly, we aimed to explore whether body mindsets were associated with psychological distress beyond demographic factors, treatment modalities, and comorbidities. We hypothesised that a more unhelpful body mindset (my Body is an Adversary) would be associated with poorer psychological distress, while more helpful body mindsets (my Body is Capable and my Body is Responsive) would be associated with less psychological distress, even while controlling for demographic factors, treatment modalities, and comorbidities.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study uses a cross-sectional convergent parallel mixed-methods approach, whereby two types of data (quantitative and qualitative) are collected, analysed, and then integrated for interpretation. An intra-method technique (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) was used in which data were collected using a single method, in this case an online survey, to produce quantitative (closed-ended questions) and qualitative (free-text response questions) data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eIndividuals were eligible if they were over the age of 18, living in the United Kingdom at the time of completing the survey, and receiving treatment for chronic kidney disease (CKD). This included people with CKD stages 3b+, people on dialysis or with a kidney transplant, or people receiving supportive care. Individuals were not eligible to take part if informed consent was not provided and if they did not indicate that they could comprehend and respond to questions in English (see Fig.\u0026nbsp;1 for the participant flow chart).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eRecruitment\u003c/h3\u003e\n\u003cp\u003eEthical approval was obtained through the Research Ethics Management Application System in the United Kingdom (HR-22/23-34712). Adults receiving treatment for CKD were recruited through CKD charities who circulated a study flyer and link, and through posting the study flyer and link on CKD-related Facebook and Twitter groups. The study flyer included a link to the online participant information sheet and consent form via Qualtrics (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.qualtrics.com\u003c/span\u003e\u003cspan address=\"https://www.qualtrics.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) where individuals could read further information about the study, complete screening questions, provide informed consent, and then complete the survey. Participants were not financially reimbursed for completing the survey. The survey was accessible from 27th February 2023 through 16th February 2024.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Data\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eDemographic Factors, Treatment Modalities, and Comorbidities\u003c/h2\u003e \u003cp\u003eParticipants self-reported demographic information including age, sex, and ethnicity. The primary cause of kidney disease, current treatments, and previous treatments for kidney disease were collected through self-report using items utilised in previous research (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Participants self-reported currently received treatments at the time of the study which are referred to as \u0026lsquo;treatment modalities\u0026rsquo; throughout this paper. Comorbidities were captured using the self-report comorbidity questionnaire (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The self-report comorbidity questionnaire was initially developed in a sample of inpatients from medical and surgical care units (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), developed based on commonly used comorbidity instruments. Sridharen and colleagues (2014) adapted this measure for patients with end-stage renal disease by utilising eight of the twelve medical conditions most relevant for patients on haemodialysis. Participants were asked three questions including whether they have the condition, whether they are receiving treatment for it, and whether it limits their daily activities. Each positive response was given a score of one, therefore a maximum score of three could be obtained for each condition. Participants were instructed to leave the question blank if they did not have the condition, had not received treatment for the condition, or if the condition did not limit their activities for each item respectively. Scores across questions for each condition were summed to generate a composite self-reported comorbidity score.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eBody Mindsets\u003c/h3\u003e\n\u003cp\u003eThe Body Mindset Inventory (BMI) comprises 10 items assessing three body mindsets in the context of chronic illness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e): Body is Capable (3 items; ω\u0026thinsp;=\u0026thinsp;.82), Body is Responsive (3 items; ω\u0026thinsp;=\u0026thinsp;.81), and Body is an Adversary (4 items; ω\u0026thinsp;=\u0026thinsp;.83). The BMI is designed such that the name of the illness being studied (in this case, CKD) is included in the questionnaire items, for example \u0026ldquo;having chronic kidney disease means my body has betrayed me\u0026rdquo;. For all items, individuals responded on a 6-point Likert scale (6\u0026thinsp;=\u0026thinsp;strongly agree, 1\u0026thinsp;=\u0026thinsp;strongly disagree) and a mean score is created for each subscale separately. Higher mean scores on each subscale indicate greater endorsement of that mindset. As each mindset is measured with separate items, participants could endorse agreement with multiple mindsets. As this measure has not been utilised in a CKD population previously, a Confirmatory Factor Analysis was conducted to confirm the three-factor structure of the BMI in the sample.\u003c/p\u003e\n\u003ch3\u003ePsychological Distress\u003c/h3\u003e\n\u003cp\u003eThe Patient Health Questionnaire 4-item (PHQ-4) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) combines the two screening items from the Patient Health Questionnaire 2-item (PHQ-2) and the General Anxiety Disorder 2-item (GAD-2) to measure core signs of depression and anxiety, respectively. The PHQ-4 (ω\u0026thinsp;=\u0026thinsp;.91) is a brief measure that reduces patient survey burden and excludes items that assess somatic symptoms that may confound the measurement of distress with assessment of medical comorbidities. For each item, participants answer how often they were bothered by the problem in the last two weeks on a 4-point Likert scale (0\u0026thinsp;=\u0026thinsp;not at all, 3\u0026thinsp;=\u0026thinsp;nearly every day), and items are summed to create a total score. Aligning with its use in health research, we refer to the total composite score as psychological distress, wherein higher scores reflect more psychological distress (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Data\u003c/h2\u003e \u003cp\u003eAfter completing the BMI, participants were asked: \u0026ldquo;\u003cem\u003eIn your own words, please describe how you think and feel about your body. We are interested not in how you think your body looks, but how your body works and doesn't work, how your body functions, and how your body supports you in everyday life.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses\u003c/h2\u003e \u003cp\u003eQuantitative data were analysed and visualised using Statistical Packages for the Social Sciences (SPSS) version 29 0.1.0 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and R version 4.2.2. A Confirmatory Factor Analysis (CFA) was conducted to confirm the factor structure of the BMI given its novel use in CKD. Pearson correlations examined univariate associations of continuous variables including body mindsets with age, comorbidities, and psychological distress. Independent sample \u003cem\u003et\u003c/em\u003e-tests examined associations of continuous variables with sex. Analyses of Variance (ANOVA) explored associations of continuous variables with treatment modalities which comprised five groups: advanced kidney care, in-centre haemodialysis, home dialysis (including peritoneal dialysis and continuous ambulatory peritoneal dialysis), kidney transplant, and supportive/conservative care. Significance levels were set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, two-tailed. Hierarchical linear regression analyses examined unique variance in psychological distress explained by body mindsets adjusting for age, sex, treatment modalities, and comorbidities. In Step 1, age and sex were entered into the model, followed by treatment modalities and comorbidities in Step 2 (dummy coded, with dialysis recipients as the reference category). In Steps 3a, 3b and 3c, each body mindset\u0026mdash;Body is Capable, Body is Responsive, and Body is an Adversary\u0026mdash;were added individually. In Step 4, all three body mindsets were added simultaneously to assess the total variance in psychological distress associated with body mindsets beyond demographics factors, treatment modalities, and comorbidities. All variables were added using the enter method.\u003c/p\u003e \u003cp\u003eThe qualitative freely-generated responses were analysed using a two-staged process using Miro, an online tool for brainstorming and mapping ideas on digital boards (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The primary coder (EJD) first familiarised herself with the data through reading and re-reading the responses, while recursively coding data in Miro. In the first stage, coding was conducted deductively by using the three body mindset subscales from the BMI as the overarching codes. The BMI considers body mindset subscales that are worded to reflect one dimension of each mindset (e.g. my Body is Capable), with no reverse-scored items. Mindsets can however be understood across a two-dimensional spectrum; using the Capable mindset example, people may fall anywhere along the spectrum of strongly endorsing the mindset that their Body is Capable to strongly endorsing the mindset that their Body is Incapable. Therefore, qualitative data were purposely coded across a two-dimensional spectrum for each mindset. In addition, qualitative data were further coded inductively to identify possible novel body mindsets not captured by the BMI. Coding was discussed iteratively with two additional researchers with expertise in qualitative data analyses for health psychology research (LCH) and the psychological science of mindsets (AJC).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eIntegration of Quantitative and Qualitative Data\u003c/h2\u003e \u003cp\u003eIntegration of quantitative BMI data and qualitative free-response data was conducted via joint display using a matrix to generate meta-inferences. The primary aim of data integration was complementarity, in which the quantitative BMI data were illustrated with the qualitative free-response data to enhance understanding and extend the scope of inquiry (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). To do this, a joint display was created that juxtaposed data to illustrate how the BMI subscales across a two-dimensional spectrum mapped onto the qualitative free-response quotes. A row was added to illustrate potentially novel body mindsets reported by patients that appeared distinct to those in the current BMI. A meta-inference was provided for complementarity, elaboration, and illustration across the two types of data. Specifically, meta-inferences enabled examination of how quantitative and qualitative data complemented or enriched one another (complementarity), how qualitative data provided examples of the BMI subscales (illustration), and how the qualitative data provided a more detailed understanding of the BMI subscale scores (elaboration) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Results\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eSample Characteristics\u003c/h2\u003e \u003cp\u003eOf the 292 participants that commenced the survey, 232 completed or partially completed the study measures (see Fig.\u0026nbsp;1 for participant flowchart). For those who responded to at least 80% of items across measures (excluding the comorbidities scale, which contained true zeros), prorating was applied to compute values for missing items. Prorated scores were then used to calculate total scores. Participants who responded to less than 80% of items across measures were excluded from analyses. Sensitivity analyses were performed to assess how the results varied depending on the missing data techniques used. Multiple imputation was performed on a separate dataset in SPSS version 29 0.1.0 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) using the automatic imputation model with 10 iterations. Analyses were replicated across different missing data techniques. Results from the pooled multiple imputed datasets can be found in the Supplementary files. Most participants were aged 46\u0026ndash;55, self-identified as White (91.5%), and female (61.9%). The most common current treatment reported was \u0026lsquo;kidney transplant\u0026rsquo; (34.7%; see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for medical and demographic information).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedical and demographic information of the sample.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u0026ndash;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66\u0026ndash;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u0026ndash;85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Binary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian or Asian British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed or Multiple Ethnic Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack, Clack British, Caribbean, or African\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther Ethnic Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Cause of Kidney Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlomerulonephritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolycystic Kidney Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLupus or Vasculitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI do not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Treatment Modalities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdvanced Kidney Care/ Low Clearance Kidney Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn-Centre Haemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome Haemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous Ambulatory Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKidney Transplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupportive/ Conservative Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn-centre Haemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome Haemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous Ambulatory Peritoneal Dialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKidney Transplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (30.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Applicable / None of the above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHas Condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReceives Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLimits Activities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeart disease such as angina or poor heart function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious Heart Attack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLung Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis for the Body Mindset Inventory\u003c/h2\u003e \u003cp\u003eGiven that the BMI had not previously been used in a CKD sample, a CFA was conducted in Mplus to confirm the three-factor structure of the BMI. In CFA, a non-significant chi-squared is desired and standard model fit indices were evaluated including; the Comparative Fit Index (CFI) and Tucker-Lewis index (TLI), with values exceeding .90 indicating good fit, although \u0026ge;\u0026thinsp;.95 is preferred (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Additionally, the root mean square error of approximation (RMSEA) was evaluated with a value of \u0026lt;\u0026thinsp;.08 considered to demonstrate approximate fit. The model had a good fit as determined by the CFI (.94), TLI (.92), and RMSEA (.003) indices. The significant chi-squared indicated a poor model fit (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;87.82, df\u0026thinsp;=\u0026thinsp;32, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.00), although chi-squared values are largely influenced by sample size. All items revealed factor loadings exceeding .60 indicating that items loaded appropriately onto their respective factors. Overall, results of the CFA suggest that the three-factor structure of the BMI holds in the sample of people with CKD. Standardised factor loadings are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBody Mindset Descriptive Results\u003c/h2\u003e \u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, scores on each body mindset subscale were widely distributed reflecting substantial individual variability in the mindsets that adults with CKD hold about their bodies. The median endorsement for each mindset fell in the \u0026ldquo;somewhat disagree\u0026rdquo; range for the Body is Capable mindset (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.0, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.34) and the \u0026ldquo;somewhat agree\u0026rdquo; to \u0026ldquo;somewhat disagree\u0026rdquo; range for both the Body is Responsive (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.3, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.67) and Body is an Adversary mindsets (\u003cem\u003eMdn\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.3, \u003cem\u003eIQR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.75). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the Body is Capable and Body is Responsive mindsets were positively and moderately associated with one another. The Body is an Adversary mindset was negatively and moderately associated with the Body is Responsive mindset and the Body is Capable mindset.\u003c/p\u003e \u003cp\u003eTo quantify endorsement of each mindset in terms of agreement and disagreement, those who scored 1\u0026ndash;3 on each subscale were considered to disagree with endorsing the mindset, whereas those who scored\u0026thinsp;\u0026gt;\u0026thinsp;3\u0026ndash;6 on each subscale were considered to agree with endorsing the mindset. Overall, 45.3% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;105) of participants agreed with the mindset that my Body is Capable, 54.5% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;126) of participants agreed with the mindset that my Body is Responsive, and 55.0% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;126) of participants agreed with the mindset that my Body is an Adversary.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eBody Mindsets Across Demographic Factors, Treatment Modalities, and Comorbidities\u003c/h2\u003e \u003cp\u003eAs seen in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, endorsement of body mindsets were not different across sex or age. Results from ANOVAs indicated that there was a significant relationship between current treatment modalities and endorsement of the mindsets that my Body is Capable and Body is an Adversary. Bonferroni post-hoc tests indicated that those receiving advanced kidney care (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.58) were less likely to endorse the mindset that my Body is Capable compared to home dialysis recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.31; mean difference\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.73) and kidney transplant recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.16, mean difference\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.58). Additionally, advanced kidney care recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.90) were more likely to endorse the mindset that my Body is an Adversary compared to kidney transplant recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.83; mean difference\u0026thinsp;=\u0026thinsp;1.06). In-centre dialysis recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.72) were more likely to endorse the mindset that my Body is an Adversary compared to kidney transplant recipients (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.83; mean difference\u0026thinsp;=\u0026thinsp;.88). Reporting a greater number of comorbidities was associated with greater endorsement of the Body is an Adversary mindset and less endorsement of the Body is Capable and Body is Responsive mindsets (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate associations of body mindsets with demographic variables, treatment modalities, and comorbidities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Body is an Adversary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Body is Capable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.316**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Body is Responsive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.324**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.582**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Psychological Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.340**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.314**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.302**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.169*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.209**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.230**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.167*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Treatment Modalities (F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.99***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.00*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.60*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.281***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.279***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Sex (\u003cem\u003et\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.52***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote. \u003cem\u003eF\u003c/em\u003e-values from Analyses of Variance (ANOVA) present associations of treatment modalities and \u003cem\u003et\u003c/em\u003e-values present associations with sex, *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eBody Mindsets and Psychological Distress\u003c/h2\u003e \u003cp\u003eIn correlational analyses, greater endorsement of the Body is an Adversary mindset was associated with higher psychological distress, whereas greater endorsement of the Body is Capable and Body is Responsive mindsets were associated with lower psychological distress. In hierarchical linear regression analyses and as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, all three body mindsets were significantly associated with psychological distress while controlling for demographic factors, treatment modalities, and comorbidities. Greater endorsement of the Body is an Adversary mindset was associated with more psychological distress while greater endorsement of the Body is Capable and Body is Responsive mindsets were associated with less psychological distress. When all three mindsets were entered into the same regression model (Step 4), the Body is an Adversary mindset remained significantly associated with psychological distress. Together, the three body mindsets contributed 12% of the variance in psychological distress and all variables in the model contributed 24% of the variance psychological distress.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnique associations of body mindsets with psychological distress beyond demographic factors, treatment modalities, and comorbidities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eStep 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eStep 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStep 3a\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eStep 3b\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eStep 3c\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eStep 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDemographic Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.03 (-1.28, .84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02 (-1.18, .92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.03 (-1.24, .78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.06 (-1.45, 1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e.01 (-.90, 1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02 (1.11, .88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.28*** (-1.08, \u0026minus;\u0026thinsp;.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.36*** (-1.28, \u0026minus;\u0026thinsp;.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.34*** (-1.21, \u0026minus;\u0026thinsp;.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.35*** (-1.25, \u0026minus;\u0026thinsp;.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.33*** (-1.19, \u0026minus;\u0026thinsp;.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.32*** (-1.17, \u0026minus;\u0026thinsp;.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMedical-Related Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eTransplant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01(-1.29, 1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.001 (-1.20, 1.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01 (-1.21, 1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e.08 (-.59, 1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e.06 (-.68, .1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAdvanced Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e.02 (-1.25, 1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01 (-1.53, .1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01 (-1.46, 1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.12 (-1.53, 1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.04 (-1.70, 1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSupportive Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e.001 (-1.50, 1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.001 (-1.45, 1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02 (-1.56, 1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02 (-1.22, 1.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.01 (-1.35, 1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e.27*** (.18, .57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.22* (.11, .50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e.21* (.10, .48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e.22*** (.13, .60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e.18* (.07, .45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBody Mindsets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBody is Capable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.23*** (-1.27, \u0026minus;\u0026thinsp;.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.08 (-.83, .25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBody is Responsive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.27*** (-1.33, \u0026minus;\u0026thinsp;.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.14 (.99, .05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBody is Adversary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e.33*** (.62, 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e.26*** (.39, 1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c16\" namest=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAdj R\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e Statistic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8.66***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e5.69***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e8.75***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e7.72***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e8.95***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e8.17***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01, ***\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001. Dummy coded treatment variables present differences in advanced kidney care, supportive/conservative care and transplant recipients between dialysis recipients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Results\u003c/h2\u003e \u003cp\u003eOverall, 195 participants responded to the free-text response question. These qualitative data supported and further illustrated the mindsets captured in the BMI as well as providing insight into the opposite end of each mindset dimension (e.g., illustrating the opposite end of the mindset that the Body is an Adversary, specifically the Body is an Ally) while offering insights into potential novel mindsets not captured by the BMI. Meta-inferences from integrating quantitative and qualitative data are summarised in the table below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeta-Inference table integrating qualitative and quantitative body mindset data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mindset\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative Quote and Quantitative BMI Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeta-Inference from integrating Qualitative and Quantitative Data\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody is an Adversary / Body is an Ally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lsquo;Adversary\u0026rsquo; exemplars (BMI Adversary scores 5.25-6.00)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;It is like living with a ticking time bomb and you have no idea what will detonate it and when it will blow up\u0026rdquo;.\u003c/b\u003e (Female aged 56\u0026ndash;65)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;It just feels like whatever the surgeons/renal team try to do to help me, my body finds a way to object\u0026rdquo;.\u003c/b\u003e (Female aged 46\u0026ndash;55)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body is useless and has betrayed me\u0026rdquo;.\u003c/b\u003e (Female aged 26\u0026ndash;35)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lsquo;Ally\u0026rsquo; exemplars (BMI Adversary scores 1.00-1.50)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I will work with my body to deal with it as well as I can \u0026ndash; we have a good relationship\u0026rdquo;.\u003c/b\u003e (Female aged 26\u0026ndash;35)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;Up until this point my body has taken care of me. Now it\u0026rsquo;s my turn to take care of it\u0026rdquo;.\u003c/b\u003e \u003cem\u003e(\u003c/em\u003eFemale aged 36\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThere were several illustrative examples of the mindset \u0026lsquo;My Body is an Adversary\u0026rsquo; in people with CKD. Participants described their body as unpredictable, with symptoms arising unexpectedly and a constant sense of waiting for something to go wrong. Some felt their body actively worked against them, rejecting medical interventions. Participants who held this mindset described their body as an enemy, including examples of betrayal and deception.\u003c/p\u003e \u003cp\u003eOn the opposite side of this dimension, participants who scored low on this BMI subscale qualitatively reported viewing their body as an Ally. They described that their body had taken care of them and supported them throughout their CKD journey. They described a body that was working with them, rather than against them. In return, participants described a motivation to care of their body.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody is Capable / \u003c/p\u003e \u003cp\u003eBody is Incapable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lsquo;Capable\u0026rsquo; exemplars (BMI Capable scores 3.67\u0026ndash;5.67)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I am content that my body works within the boundaries set for it\u0026rdquo;.\u003c/b\u003e (Male aged 66\u0026ndash;76\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I think my body is pretty strong. It deals with a lot after all\u0026rdquo;.\u003c/b\u003e (Female aged 36\u0026ndash;45)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lsquo;Incapable\u0026rsquo; exemplars (BMI Capable scores 2.67)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body clearly doesn\u0026rsquo;t work\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Male aged 26\u0026ndash;35)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body is unable to handle some things that were perfectly normal before: it is no longer as strong as it was...It is a strange feeling, knowing my body needs help and no longer functions as well as it used to\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female aged 36\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant quotes illustrated how they viewed their bodies as Capable or Incapable in the context of CKD. Some participants described that they felt their body was doing its best to manage CKD, despite the challenges and boundaries set by the condition. Others described believing that their body is able to cope with CKD and support them in their valued life goals.\u003c/p\u003e \u003cp\u003eOn the opposite side of this dimension, participants described that their body was incapable, unable to rise to the occasion when needed, or overcome challenges from CKD treatment. Similarly, some described that the limited support provided by their body in achieving their life goals was insufficient.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody is Responsive / Body is not Responsive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lsquo;Responsive / not Responsive\u0026rsquo; exemplars\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I am proud of how my body has recovered and healed from illness, operations and surgeries, it has been very resilient\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female aged 26\u0026ndash;35, BMI Body is Responsive score: 1.33).\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body has a high tolerance in general, it heals well after operations\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female, aged 36\u0026ndash;45, BMI Body is Responsive score: 3.67).\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body takes longer to heal after illness or injury\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female, aged 56\u0026ndash;65, BMI Body is Responsive score: 3.67).\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I've noticed an increase in healing times over wounds and general infections\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Male aged 26\u0026ndash;35, BMI Body is Responsive score: 4.33).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants wrote several descriptions of their body\u0026rsquo;s capabilities to heal and recover within the context of CKD, aligning with the content on the BMI Body is Responsive subscale. However, unlike the other mindsets illustrated above, qualitative responses did not closely match quantitative responses on this BMI subscale. For example, one participant who scored low (1.33 out of 6) on the Body is Responsive BMI subscale wrote that that they were proud of how their body had recovered and healed and described their body as \u0026lsquo;resilient\u0026rsquo;.\u003c/p\u003e \u003cp\u003eAs another example, two participants with equivalent scores of 3.67 out of 6 on the Body is Responsive BMI subscale described their bodies in quite different ways, with one describing their body as healing well after operations and the other describing their body as taking longer to heal after illness or injury. Lastly, one participant who scored relatively high on the BMI Responsive subscale (4.33 out of 6) described that their body took longer to heal from wounds and general infections.\u003c/p\u003e \u003cp\u003eQuantitative and qualitative data integration indicate that the body\u0026rsquo;s capacity to heal and recover is relevant for people with CKD but that the BMI Responsive subscale may not adequately capture the full variation of beliefs in this context.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePotential New Mindsets Not Captured in the BMI\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBody is Amazing\u003c/p\u003e \u003cp\u003eBody is Dysfunctional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body is brilliant. Despite immunosuppression I rarely get ill, I am generally fitter, happier and healthier than I was pre transplant\u0026hellip; My body is a remarkable thing, the third kidney just quietly cracks on with doing the job the other two couldn't!\u0026ldquo;.\u003c/b\u003e (Male aged 36\u0026ndash;45)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I think my body is amazing, to have been through two transplants at 35, to have stable function, and amazingly given the massive cocktail of drugs it has been subjected to over 35 years, have nothing else wrong with it\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(\u003c/em\u003eFemale, aged 26\u0026ndash;35)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My body keeps me alive and has survived so much! My body is a fighter just like me. My body is amazing\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female, aged 36\u0026ndash;45)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;If asked I\u0026rsquo;d think my body is amazing that I survived at all\u0026hellip;I am truly grateful for this bag of bones for keeping me going all this time. It\u0026rsquo;s pretty remarkable\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female, aged 46\u0026ndash;55)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;My broken, useless body\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Male, aged 66\u0026ndash;75)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;To me my body is dying from the inside out\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Male, aged 66\u0026ndash;75)\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026ldquo;I really feel like my body is breaking down\u0026rdquo;.\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Female, aged 56\u0026ndash;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInductive coding of qualitative data indicated possible novel mindsets that were not adequately captured in the BMI.\u003c/p\u003e \u003cp\u003eFirst, several participants described that their body was \u0026ldquo;amazing,\u0026rdquo; \u0026ldquo;brilliant,\u0026rdquo; and \u0026ldquo;extraordinary\u0026rdquo;. While these participants often scored high on the Body is Capable BMI subscale, their qualitative data went beyond descriptions of the body merely being capable, indicating a possibly distinct \u0026lsquo;Body is Amazing\u0026rsquo; mindset. Quotes coded to reflect this mindset were not oriented around comparison of one\u0026rsquo;s body to others, but rather an expression of awe at the body\u0026rsquo;s functioning. Participants describing their body as a fighter that continues to function astonishingly well, even with CKD, expressed gratitude for their body.\u003c/p\u003e \u003cp\u003eSecond, other participants described their body as \u0026ldquo;dysfunctional\u0026rdquo; and \u0026ldquo;broken\u0026rdquo;. While participants describing their bodies in this way scored relatively high on the Body is an Adversary mindset, these qualitative codes did not reflect the active adversarial qualities of the body but rather a more passive brokenness and uselessness.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed methods study explored body mindsets and their associations with psychological distress in people with CKD. Findings revealed wide variation in the extent to which individuals endorsed mindsets such as my Body is Capable, my Body is Responsive, and my Body is an Adversary. These mindsets independently correlated with psychological distress, even after adjusting for demographic factors, treatment modalities, and comorbidities. Since mindsets are relatively easy to assess, incorporating mindset assessments into clinical practice may offer practical benefits for patient care. Future research should examine whether targeting these mindsets through clinical and psychological interventions can improve distress and outcomes in CKD supportive care.\u003c/p\u003e \u003cp\u003ePsychological distress is the most common psychological issue in CKD, associated with faster kidney function decline, increased hospitalisations, and a higher number of comorbidities (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Despite its prevalence and impact, psychological distress is not routinely assessed or managed in CKD care (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). As distress levels tend to rise with disease progression (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), effective management is essential to slow deterioration and reduce the need for invasive treatments (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Identifying risk and resilience factors for distress can inform interventions to help patients cope with CKD and improve outcomes (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Although our data are cross-sectional, findings suggest that body mindsets act as both risk and resilience factors for psychological distress in CKD. Specifically, stronger endorsement of the Body is an Adversary mindset was associated with higher distress, indicating its potential role in poorer CKD management and health outcomes. In contrast, endorsing the Body is Capable and Body is Responsive mindsets was associated with lower psychological distress, suggesting they may foster resilience. These associations remained significant after controlling for demographics, treatment modalities, and comorbidities.\u003c/p\u003e \u003cp\u003eOur findings align with broader research on illness beliefs in CKD, particularly perceptions of controllability (e.g., \u0026ldquo;There is little that can be done to improve my illness\u0026rdquo;) and coherence (e.g., \u0026ldquo;I don\u0026rsquo;t understand my illness\u0026rdquo;), both linked to greater distress (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Moreover, a meta-analysis identified cognitive appraisals as key associates of psychological distress, emphasising the role of illness and body perceptions in its development and maintenance (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This study builds on existing literature by highlighting the importance of functional body beliefs \u0026ndash; specifically, whether individuals see their bodies as capable of responding to and tolerating treatments like dialysis. Given CKD\u0026rsquo;s progressive nature and ongoing challenges, future research should explore whether identifying unhelpful body mindsets and shifting towards more helpful ones can foster resilience, empower patients in disease management, and reduce distress.\u003c/p\u003e \u003cp\u003eOur secondary aim was to explore associations between body mindsets and demographic factors, treatment modalities, and comorbidities. We observed no significant relationships between body mindsets and age or sex, aligning with prior research in cancer patients and survivors (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, in adolescents (aged 8\u0026ndash;17) with chronic pain, body mindsets varied by age and sex (Dowling et al 2025; under review). Regarding comorbidities, individuals with CKD who had more comorbidities more strongly endorsed the Body is an Adversary mindset and less strongly endorsed the Body is Capable and Responsive mindsets. Differences also emerged across treatment modalities. Advanced kidney care recipients were less likely to endorse the Body is Capable mindset and more likely to view their Body as an Adversary compared to kidney transplant recipients. Since advanced kidney care focuses on managing disease progression and preparing for kidney replacement therapy, it might highlight bodily limitations rather than potential. In contrast, a kidney transplant can symbolise renewed function, fostering hope and a sense of capability, potentially shifting perceptions away from adversarial views of the body. Similarly, in-centre dialysis recipients were more likely to endorse the Body is an Adversary mindset compared to transplant recipients. The structured, externally controlled nature of in-centre dialysis, coupled with rigid treatment schedules, may amplify feelings of bodily betrayal or inadequacy. For many dialysis patients, particularly those ineligible for transplantation, the lack of a definitive treatment endpoint may reinforce perceptions of ongoing struggle and loss of autonomy. Additionally, the greater symptom burden and diurnal variations in well-being associated with haemodialysis can exacerbate frustration with the body (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings suggest opportunities for interventions targeting body mindsets to enhance coping and quality of life in CKD treatment. For example, mindset interventions delivered after haemodialysis could help individuals reframe their experiences and cultivate a more adaptive perspective on bodily changes. Such interventions could emphasise resilience and the body\u0026rsquo;s capacity to adapt to treatment demands. Future research should assess the feasibility and efficacy of such approaches, particularly in addressing the unique psychological and physical stressors faced by in-centre dialysis patients.\u003c/p\u003e \u003cp\u003eWe asked people with CKD to describe their body mindsets using a free-text response, revealing alignment with predefined body mindsets in the BMI. Descriptions of the body as an unpredictable opponent reflected the Body is an Adversary mindset, while viewing the body as effectively managing CKD challenges aligned with the Body is Capable mindset. Similarly, perceiving the body as able to recover and heal corresponded to the Body is Responsive mindset. Notably, participants also expressed perspectives beyond these predefined mindsets. Some described their body as an ally that worked with them, representing the opposite end of the Body is an Adversary mindset spectrum. Others felt their body provided insufficient support in daily life, suggesting a Body is Incapable mindset. Interestingly, alignment between quantitative and qualitative data was weaker for the Body is Responsive mindset, indicating the need for further refinement of this BMI subscale in CKD. Additionally, qualitative responses suggested other mindsets not captured by the BMI, such as viewing the body as Dysfunctional or Amazing.\u003c/p\u003e \u003cp\u003eMindsets can be modified through psychologically wise interventions, which introduce helpful perspectives during periods of uncertainty to improve well-being, health, and behaviour (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Brief, digital mindset interventions have shown promise in improving coping, symptom distress, and quality of life in cancer patients by targeting illness and body mindsets (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The qualitative findings from this study suggest that people with CKD can view their body as \u0026lsquo;capable\u0026rsquo;, \u0026lsquo;resilient\u0026rsquo;, and \u0026lsquo;amazing\u0026rsquo;, offering valuable insights for development mindset interventions. Embedding real patient narratives can reinforce the plausibility of these mindsets. Additionally, acknowledging how CKD diagnosis and treatment can contribute to adversarial or broken body perceptions may help normalise, validate, and destigmatise these experiences \u0026ndash; an essential first step toward mindset change. Brief digital storytelling interventions illustrating mindset shifts despite adversity could help individuals with CKD recognise their body mindsets, understand their impact, and develop skills to adopt more helpful body mindsets. Integrating such interventions into care at key moments, such as diagnosis dialysis initiation, could provide timely psychological support and improve health outcomes.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, our sample were largely female and White. Since sex and gender differences are common in body image research, further exploration of body mindsets in men and racially diverse CKD populations is needed. Second, the cross-sectional design prevents causal conclusions \u0026ndash; while body mindsets may influence psychological distress, distress could also reinforce certain body mindsets. Third, CKD\u0026rsquo;s progressive nature may shape these relationships over time, warranting longitudinal or interventional studies. Additionally, the qualitative free-text response was placed after the BMI items to illustrate quantitative findings. However, asking participants to generate their body mindsets beforehand might have revealed additional perspectives. In-depth qualitative interviews could also provide richer insights into the CKD-related body mindsets and the language used to express them. Lastly, online recruitment allowed us to reach participants beyond a single clinical site but may limit generalisability, particularly for individuals less engaged with online CKD communities.\u003c/p\u003e \u003cp\u003eIn conclusion, our findings indicate the diverse body mindsets of people with CKD, ranging from viewing the body as an adversary to recognising its resilience and strength. These mindsets were uniquely associated with psychological distress, independent of demographic factors, treatment modalities, and comorbidities. Future experimental research should explore whether shifting body mindsets in this population can help reduce psychological distress.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatement Regarding Informed Consent:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement Regarding Ethical Approval:\u0026nbsp;\u003c/strong\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee, as described in the manuscript, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\u003cp\u003e \u003ch2\u003eConflict of Interest:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTS led the ethical approval process and the initial phase of data collection, with contributions from JC and LCH.EJD contributed to data collection, conceptualised the study, conducted the analysis, and wrote the original draft.LCH and JC supervised the project and contributed to the study\u0026rsquo;s overall conceptualisation.AJC contributed to the study's conceptualisation and interpretation of findings.AJC, JC, and LCH reviewed and edited the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank the participants for taking part in the study and the following organisations for their support with recruitment for the project: Kidney Care UK, Kidney Research UK, National Kidney Federation, and the UK Kidney Association.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMehrotra R, Davison SN, Farrington K, Flythe JE, Foo M, Madero M, et al. Managing the symptom burden associated with maintenance dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney international. 2023;104(3):441-54.\u003c/li\u003e\n\u003cli\u003eCouser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney international. 2011;80(12):1258-70.\u003c/li\u003e\n\u003cli\u003eMartini A, Ammirati A, Garcia C, Andrade C, Portela O, Cendoroglo MS, et al. Evaluation of quality of life, physical, and mental aspects in longevous patients with chronic kidney disease. International urology and nephrology. 2018;50:725-31.\u003c/li\u003e\n\u003cli\u003eZion SR. From Cancer to COVID-19: the Self-Fulfilling Effects of Illness Mindsets on Physical, Social, and Emotional Functioning: Stanford University; 2021.\u003c/li\u003e\n\u003cli\u003eZion SR, Schapira L, Berek JS, Spiegel D, Dweck CS, Crum AJ. Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psycho-Oncology. 2023;32(9):1433-42.\u003c/li\u003e\n\u003cli\u003eZeidman A, Benedict C, Zion SR, Fisher S, Tolby L, Kurian AW, et al. Association of illness mindsets with health-related quality of life in cancer survivors. Health Psychology. 2022;41(6):389.\u003c/li\u003e\n\u003cli\u003eCrum A, Akinola M, Martin A, Fath S. The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, Stress, \u0026amp; Coping. 2017;30(4):379-95.\u003c/li\u003e\n\u003cli\u003eCrum AJ, Salovey P, Achor S. Rethinking stress: the role of mindsets in determining the stress response. Journal of personality and social psychology. 2013;104(4):716.\u003c/li\u003e\n\u003cli\u003ePalmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney International. 2013;84(1):179-91.\u003c/li\u003e\n\u003cli\u003eDos Santos PR, Mendon\u0026ccedil;a CR, Hernandes JC, Borges CC, Barbosa MA, de Sousa Romeiro AM, et al. Pain in patients with chronic kidney disease undergoing hemodialysis: A systematic review. Pain Management Nursing. 2021;22(5):605-15.\u003c/li\u003e\n\u003cli\u003eTsai Y-C, Chiu Y-W, Hung C-C, Hwang S-J, Tsai J-C, Wang S-L, et al. Association of Symptoms of Depression With Progression of CKD. American Journal of Kidney Diseases. 2012;60(1):54-61.\u003c/li\u003e\n\u003cli\u003eAlshelleh S, Alhouri A, Taifour A, Abu-Hussein B, Alwreikat F, Abdelghani M, et al. Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients. Scientific Reports. 2022;12(1):17627.\u003c/li\u003e\n\u003cli\u003eChilcot J, Guirguis A, Friedli K, Almond M, Day C, Da Silva-Gane M, et al. Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis. Annals of Behavioral Medicine. 2017;52(1):1-8.\u003c/li\u003e\n\u003cli\u003eHedayati S, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney International. 2012;81(3):247-55.\u003c/li\u003e\n\u003cli\u003eDowling EJ, Simons LE, Crum AJ, Spunt SL, Simon P, Webster SN, et al. Body mindsets are associated with pain and threat-related risk factors for pain in survivors of childhood cancer. The Journal of Pain. 2023.\u003c/li\u003e\n\u003cli\u003eJohnson B, Turner LA. Data collection strategies in mixed methods research. Handbook of mixed methods in social and behavioral research. 2003;10(2):297-319.\u003c/li\u003e\n\u003cli\u003eChilcot J, Pearce CJ, Hall N, Rehman Z, Norton S, Griffiths S, et al. Depression and anxiety in people with kidney disease: understanding symptom variability, patient experience and preferences for mental health support. Journal of nephrology. 2025:1-12.\u003c/li\u003e\n\u003cli\u003eSridharan S, Berdeprado J, Vilar E, Roberts J, Farrington K. A self-report comorbidity questionnaire for haemodialysis patients. BMC Nephrology. 2014;15(1):134.\u003c/li\u003e\n\u003cli\u003eSangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis Care \u0026amp; Research. 2003;49(2):156-63.\u003c/li\u003e\n\u003cli\u003eKroenke K, Spitzer RL, Williams JB, L\u0026ouml;we B. An ultra-brief screening scale for anxiety and depression: the PHQ\u0026ndash;4. Psychosomatics. 2009;50(6):613-21.\u003c/li\u003e\n\u003cli\u003eAdzrago D, Walker TJ, Williams F. Reliability and validity of the Patient Health Questionnaire-4 scale and its subscales of depression and anxiety among US adults based on nativity. BMC Psychiatry. 2024;24(1):213.\u003c/li\u003e\n\u003cli\u003eKroenke K, Baye F, Lourens SG. Comparative validity and responsiveness of PHQ-ADS and other composite anxiety-depression measures. Journal of Affective Disorders. 2019;246:437-43.\u003c/li\u003e\n\u003cli\u003eIBM C. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp; 2021.\u003c/li\u003e\n\u003cli\u003eLee LJ. Tools: MIRO Real-time board, visual collaborations and tools, easy screen sharing and presentation. 2019.\u003c/li\u003e\n\u003cli\u003eBryman A. Integrating quantitative and qualitative research: how is it done? Qualitative Research. 2006;6(1):97-113.\u003c/li\u003e\n\u003cli\u003eGreene JC, Caracelli VJ, Graham WF. Toward a conceptual framework for mixed-method evaluation designs. Educational evaluation and policy analysis. 1989;11(3):255-74.\u003c/li\u003e\n\u003cli\u003eBentler PM. Comparative fit indexes in structural models. Psychological Bulletin. 1990;107(2):238-46.\u003c/li\u003e\n\u003cli\u003eHedayati SS, Finkelstein FO. Epidemiology, Diagnosis, and Management of Depression in Patients With CKD. American Journal of Kidney Diseases. 2009;54(4):741-52.\u003c/li\u003e\n\u003cli\u003eJansen DL, Heijmans MJ, Rijken M, Spreeuwenberg P, Grootendorst DC, Dekker FW, et al. Illness perceptions and treatment perceptions of patients with chronic kidney disease: different phases, different perceptions? Br J Health Psychol. 2013;18(2):244-62.\u003c/li\u003e\n\u003cli\u003eMuscat P, Chilcot J, Weinman J, Hudson J. Exploring the relationship between illness perceptions and depression in patients with chronic kidney disease: A systematic literature review. Journal of Renal Care. 2018;44(3):174-85.\u003c/li\u003e\n\u003cli\u003eZalai D, Szeifert L, Novak M. Psychological Distress and Depression in Patients with Chronic Kidney Disease. Seminars in Dialysis. 2012;25(4):428-38.\u003c/li\u003e\n\u003cli\u003eTian X, Gao Q, Li G, Zou G, Liu C, Kong L, et al. Resilience is associated with low psychological distress in renal transplant recipients. General Hospital Psychiatry. 2016;39:86-90.\u003c/li\u003e\n\u003cli\u003eJansen DL, Grootendorst DC, Rijken M, Heijmans M, Kaptein AA, Boeschoten EW, et al. Pre-dialysis patients\u0026apos; perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study. BMC nephrology. 2010;11:1-10.\u003c/li\u003e\n\u003cli\u003eChilcot J. The importance of illness perception in end-stage renal disease: associations with psychosocial and clinical outcomes. Semin Dial. 2012;25(1):59-64.\u003c/li\u003e\n\u003cli\u003eChan R, Steel Z, Brooks R, Heung T, Erlich J, Chow J, et al. Psychosocial risk and protective factors for depression in the dialysis population: A systematic review and meta-regression analysis. Journal of Psychosomatic Research. 2011;71(5):300-10.\u003c/li\u003e\n\u003cli\u003eKallem CJ, Alghwiri AA, Yabes J, Erickson S, Han Z, Roumelioti M-E, et al. Diurnal and Daily Symptom Variation in Patients with End Stage Kidney Disease: An Ecological Momentary Assessment Study. Clinical Journal of the American Society of Nephrology. 2024;19(10):1292-300.\u003c/li\u003e\n\u003cli\u003eWalton GM, Crum AJ. Handbook of wise interventions: Guilford Publications; 2020.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chronic Kidney Disease, Body Mindsets, Core Beliefs, Psychological Distress, Depression","lastPublishedDoi":"10.21203/rs.3.rs-6464039/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6464039/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study investigated the association between body mindsets-established, but mutable beliefs a person holds about their body-with psychological distress in people with chronic kidney disease (CKD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional, mixed methods survey was conducted in people with CKD at a range of disease stages and treatment modalities. Participants completed the Patient Health Questionnaire-4 (PHQ-4) to capture distress, the Body Mindset Inventory (BMI), and qualitative free-text responses elaborating on their mindsets. Hierarchical regression models explored associations of body mindsets with psychological distress, controlling for demographic variables, treatment modalities, and comorbidities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo hundred and thirty-two adults with CKD (62% female) completed the survey; 27.6% were receiving dialysis and 34.7% had received a kidney transplant. Those who more strongly endorsed the mindset that their Body is an Adversary reported greater psychological distress, while those who more strongly endorsed the mindsets that their Body is Capable or Responsive reported less psychological distress. Together, all three mindsets explained 12% unique variance in psychological distress, even after accounting for demographic factors, treatment modalities, and comorbidities. Mixed-methods analyses illustrated the range of body mindsets in people with CKD, with some describing their body as “A ticking time bomb” and others stating “My body is a fighter just like me. My body is amazing.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMindsets about the body are significantly associated with psychological distress in people with CKD. These cross-sectional data provide a foundation for future longitudinal and interventional studies on the relationship between mindsets and distress outcomes in people living with CKD.\u003c/p\u003e","manuscriptTitle":"“My Body is a Ticking Time Bomb”: Associations of Body Mindsets with Psychological Distress in People with Chronic Kidney Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 09:11:48","doi":"10.21203/rs.3.rs-6464039/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4b21d95-1625-4524-8e75-aafd5e5d3529","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T16:01:42+00:00","versionOfRecord":{"articleIdentity":"rs-6464039","link":"https://doi.org/10.1007/s12529-025-10379-6","journal":{"identity":"international-journal-of-behavioral-medicine","isVorOnly":false,"title":"International Journal of Behavioral Medicine"},"publishedOn":"2025-06-27 15:57:48","publishedOnDateReadable":"June 27th, 2025"},"versionCreatedAt":"2025-05-07 09:11:48","video":"","vorDoi":"10.1007/s12529-025-10379-6","vorDoiUrl":"https://doi.org/10.1007/s12529-025-10379-6","workflowStages":[]},"version":"v1","identity":"rs-6464039","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6464039","identity":"rs-6464039","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}