Impact of Social Support on Self-Perceived Burden in Peritoneal Dialysis Patients: The Mediating Roles of Family Care and Psychological Resilience

Impact of Social Support on Self-Perceived Burden in Peritoneal Dialysis Patients: The Mediating Roles of Family Care and Psychological Resilience | 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 Impact of Social Support on Self-Perceived Burden in Peritoneal Dialysis Patients: The Mediating Roles of Family Care and Psychological Resilience Mengjiao LI, ZHAO Xujie, YANG Yan, Shuting LIU, Ping JIANG This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5821508/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To investigate the mediating effects of family care and psychological resilience in the relationship between social support and self-reported burden among patients undergoing peritoneal dialysis (PD), and to establish the foundation for the development of interventions aimed at alleviating their perceived burden. Methods A convenience sample of 539 patients PD was recruited from the nephrology departments of four hospitals in Shanghai between January and September 2024. Data were collected using self-administered questionnaires, which included sociodemographic information, the Family Care Index Questionnaire, the Psychological Resilience Scale, the Social Support Rating Scale, and the Self-Perceived Burden Scale. Pearson correlation analysis was conducted to assess the relationships among the variables, followed by the development and validation of a multiple mediation model. Results Among patients undergoing PD, the mean scores for family care, psychological resilience, social support, and self-perceived burden were 4.45 ± 2.93, 49.61 ± 18.07, 30.03 ± 8.54, and 33.13 ± 7.94, respectively. Negative correlations were identified between family care, psychological resilience, social support, and self-perceived burden in PD patients. The multiple mediation model revealed that family care played a significant mediating role in the relationship between social support and self-perceived burden, while the mediating effect of psychological resilience did not reach statistical significance. Regarding the impact of social support on self-perceived burden, the total effect was -1.516, with a direct effect of -1.131 and an indirect effect mediated by family care of 0.208. Conclusion Within the cohort of patients undergoing PD, family care plays a significant mediating role in the relationship between social support and self-perceived burden. This finding suggests that interventions aimed at strengthening family care may effectively reduce patients’ perceived burden and enhance their mental well-being during the course of clinical treatment. Peritoneal Dialysis Family Care Psychological Resilience Social Support Self- Perceived Burden Mediation Effects Introduction Peritoneal Dialysis (PD), one of the most widely used clinical treatment modalities for patients with end-stage renal disease, offers advantages in terms of ease of operation and hemodynamic stability[ 1 ]. As of the end of 2022, the estimated number of PD patients in China was approximately 140,500, with the number of patients undergoing PD treatment showing a consistent upward trend annually[ 2 ]. Self-Perceived Burden (SPB) refers to the patient's sense of emotional and financial dependence on the caregiver, leading to a range of emotional experiences, including anxiety, depression, and guilt [ 3 ]. Among long-term homebound PD patients, the high incidence of self-perceived burden leads to the development of negative emotions, such as anxiety, depression, loneliness, and social alienation. As a result, this leads to worsened treatment outcomes, increased risks of complications and mortality, and negatively impacts the quality of patient survival [ 4 ][ 5 ]. Social support is defined as the material and emotional assistance an individual receives from social connections, including relatives, friends, colleagues, or groups[ 6 ]. According to the buffer model of social support, individuals can mitigate the effects of stressors through internal perceptual systems [ 7 ]. Furthermore, social support can mitigate the negative impacts of self-perceived burdens on patients' physical and mental well-being[ 8 ]. The family unit is the primary support system for PD patients, providing emotional and financial support. As a result, patients can perceive the support from their families, which helps alleviate the burdens associated with illness and financial concerns [ 9 ]. Several studies have shown [ 10 ][ 11 ] that higher levels of family care reduce patients' self-perceived burden. It has been Psychological resilience is defined as an individual's ability to recover and adapt quickly in the face of stressors, challenges, adversities, traumas, and other significant events, potentially alleviating negative emotions and psychological distress related to illness [ 12 ]. Zhang et al [ 13 ] demonstrated that the psychological resilience of dialysis patients fluctuates in response to changes in the social support they receive. Yanlei Wang et al [ 14 ] found that psychological resilience was negatively correlated with self-perceived burden. Several studies have indicated that patients with higher levels of social support are more likely to receive emotional and financial assistance from family and friends, and perceive greater care and respect from their families. This, in turn, enhances patients' intrinsic motivation to actively confront their illnesses and treatments, thereby alleviating the burdens associated with their illnesses [ 10 ][ 15 ].It has been postulated that family care and psychological resilience are likely to assume multiple mediating functions within the context of the relationship between social support and self-perceived burden among patients with peritoneal dialysis (PD). Consequently, this research endeavor analyzed, in accordance with the multiple mediator model [ 16 ], whether family care and psychological resilience serve as mediators between social support and self-perceived burden in PD patients. The overarching objective was to furnish a reliable reference foundation for ameliorating the self-perceived burden borne by PD patients. Methods 1.1 Study Participants Convenience sampling was used to recruit peritoneal dialysis patients from the nephrology departments of four tertiary hospitals in Shanghai between January and September 2024 for a questionnaire-based survey. The inclusion criteria were as follows: (1) patients undergoing regular ambulatory peritoneal dialysis; (2) aged 18 years or older; (3) having been on peritoneal dialysis for more than one month; (4) no history of hemodialysis; (5) no communication difficulties; and (6) providing voluntary consent after being informed by the researcher.The exclusion criteria were as follows: (1) individuals with a history of mental illness, cognitive impairment, or other conditions that prevented them from completing the questionnaire; (2) individuals with serious concurrent infections or severe injuries to vital organs. Based on the sample size requirements for structural equation modeling, the sample size should be at least 10 to 20 times the number of study variables. Considering an invalidity rate of 10% to 20% [17], the estimated sample size ranged from 275 to 600 cases. A total of 539 peritoneal dialysis patients were included in the study. The study was approved by the Ethics Committee of the Shanghai Medical College of Health Sciences (Approval No. 2024-yjskt-02-410183199810067025). 1.2 Research Instruments and Tools 1.2.1 General Information Questionnaire This study developed a questionnaire to collect socio-demographic information. The information collected included the following: age, gender, body mass index (BMI), marital status, educational attainment, home address, occupation, monthly per capita income, place of residence, type of health insurance, dialysis duration (in months), and presence of complications. 1.2.2 Self - Perceived Burden Scale (SPBS) Developed by Cousineau et al. [18], this scale is primarily used to assess the self-perceived burden in patients with chronic diseases. The scale includes three dimensions: economic burden (six items), emotional burden (two items), and physical burden (two items), with a total of ten items. Scores on this scale are based on a 5-point Likert scale, with a total score ranging from 10 to 50. Higher scores indicate a greater self-perceived burden. Based on the self-perceived burden score, it is classified into four categories: no burden (<20 points), mild burden (20–29 points), moderate burden (30–39 points), and severe burden (≥40 points). In 2010, Chinese scholars Wu Yanyan et al. [19] adapted and validated the scale for the Chinese context. The content validity index of the scale was 1, the internal consistency Cronbach's coefficient was 0.91, and in this study, the Cronbach's coefficient was 0.800. 1.2.3 Connor - Davidson Resilience Scale （ CD - RISC) Developed by Connor, Davidson et al. [20] at Duke University in 2003, this scale is primarily used to assess an individual's ability to adapt and recover in the face of stress and adversity. Translated into Chinese by Yu Xiaonan et al. [21] in 2007, the scale includes three dimensions: resilience, self-reliance, and optimism. It consists of 25 items and is scored on a 5-point Likert scale ranging from 0 (never) to 4 (almost always), with a total score of 0 to 100. Higher scores indicate greater psychological resilience. The reported Cronbach's coefficient for this scale is 0.91, while in this study, the Cronbach's coefficient was 0.807. 1.2.4 Family Care Index Scale (APGAR ) Designed and developed by Smilkstein et al. [22] from the University of Washington in Seattle in 1978, this scale evaluates research participants' satisfaction with family functioning based on the characteristics of family functioning. Lv Fan et al. [23] adapted this questionnaire for the Chinese context. The questionnaire includes five dimensions: adaptation, cooperation, adulthood, affectivity, and intimacy, consisting of five items. It uses a 3-level scoring system, with a total score ranging from 0 to 10. A score of 7–10 indicates good family functioning, 4–6 indicates moderate dysfunction, and 0–3 indicates severe dysfunction. The reported Cronbach's coefficient for this scale is between 0.80 and 0.83. In this study, the Cronbach's coefficient of this questionnaire was 0.817. 1.2.5 Social Support Rating Scale (SSRS) Developed by Shao Shuiyuan et al.[24]in 1986, this scale primarily evaluates the extent of psychological support individuals receive and how they utilize it in social life.The scale includes three dimensions: objective support (three items), subjective support (four items), and social support utilization (three items), totaling ten items.The scale uses a four-point rating system. For items 1–4 and 8–10, scores range from 1 to 4. For item 5, options A, B, C, and D are scored from 1 to 4. For items 6 and 7, if the response is “no source,” the score is 0; otherwise, the score is based on the number of sources.The total score ranges from 10 to 40, with higher scores indicating a higher level of social support.The reported internal consistency of the scale is between 0.88 and 0.93, and the test-retest reliability is 0.91. In this study, the Cronbach's coefficient was 0.744. 1.3 Research Methodology After obtaining approval from the ethics committees of the hospitals, two trained researchers guided peritoneal dialysis patients, either hospitalized in nephrology departments or attending peritoneal dialysis clinics at four hospitals in Shanghai and meeting the inclusion criteria, to complete the survey using a paper-based questionnaire. The questionnaire began with an informed consent form. The researchers explained the study's purpose and content to the patients, obtained their consent, and distributed the questionnaires. Simultaneously, the researchers provided the patients with detailed instructions on how to complete the questionnaire and the associated precautions. A total of 570 questionnaires were distributed in this study. After rigorous screening, 31 questionnaires were excluded due to uniform responses and completion within less than 10 minutes, suggesting invalid data. Ultimately, 539 valid questionnaires were retrieved, yielding an effective recovery rate of 94.6%. 1.4 Statistical Methods In this study, data were first entered into an Excel spreadsheet and then analyzed using SPSS 26.0. Count data are presented as frequencies and percentages (%), while measurement data are described using the mean and standard deviation. An independent-samples t-test was used for comparisons between two groups, and analysis of variance (ANOVA) was employed for comparisons among multiple groups. Pearson correlation analysis was performed to examine the relationships between variables. Amos 26.0 software was used to construct a multiple-mediator model to analyze the mediating roles of family care and psychological resilience in the relationship between social support and self-perceived burden among PD patients. The model was fitted using the maximum-likelihood estimation method, and the mediating effect was tested with the Bootstrap method using 5,000 sampling repetitions and a 95% confidence interval. A significance level of α = 0.05 was adopted, with a P-value less than 0.05 considered statistically significant. Results 1.1 Results of Common Method Bias Test Common method bias was assessed using Harman's single-factor test. The results showed that, among 17 factors, the variance explained by the first common factor was 36.6% (< 40%). Thus, it was concluded that there was no significant common method bias in the data. 1.2 Univariate Analysis of Socio - demographic Data Regarding the Self - perceived Burden of Peritoneal Dialysis Patients The ages of the 539 patients ranged from 20 to 81 years, with a mean age of (51.32 ± 12.9) years. Of these, 232 (56.2%) were male and 181 (43.8%) were female. Significant differences were found in self-perceived burden scores with respect to age, body mass index (BMI), educational level, occupation, per capita income, health insurance payment method, dialysis duration, and presence of complications (all P < 0.05).(Table 1) Table 1: Univariate Analysis of Sociodemographic Information on Self - Perceived Burden of Peritoneal Dialysis Patients Variables Categories n (%) Mean ± SD t or F P- Value Age (yr) 18-30 35(6.5) 26.86±8.39 29.564 ＜0.001 31-45 115(21.3) 27.59±6.5 46-59 245(45.5) 34.41±6.64 60-75 135(25.0) 34.58±7.06 ＞75 9(1.7) 36.56±5.66 Sex Male 232(56.2) 32.56±7.57 0.052 0.959 Female 181(43.8) 32.53±7.48 BMI（kg/m 2 ） ＜18.5 9(1.7) 33.22±7 12.942 ＜0.001 18.5≤BMI＜24 210(39) 30.53±8.16 ＞24 320(59.4) 33.85±6.79 Marital status Unmarried 88(16.3) 32.69±7.51 0.299 0.826 Married 337(62.5) 32.51±7.58 divorced 77(14.3) 32.99±7.78 Others 37(6.9) 31.59±6.56 Education ≤Middle school 129(23.9) 37.18±6.07 60.503 ＜0.001 High school 227(42.1) 33.52±6.29 College 154(28.6) 29.09±6.94 ≥postgraduates 29(5.4) 22.59±7.73 Home Location village 177(32.8) 32.93±7.6 0.808 0.446 towns 210(39.0) 32.68±7.66 municipalities 152(28.2) 31.91±7.22 career farmer 74(13.7) 36.53±7.17 48.855 0.004 worker 11(2.0) 16.45±1.86 workforce 209(38.8) 29.54±6.16 Retirement or layoff 219(40.6) 33.88±6.91 freelance 26(4.8) 40.96±2.55 Income (Yuan) ＜5000 201(37.3) 36.38±6.1 91.34 ＜0.001 5000-10000 246(45.7) 32.09±6.6 ≥10000 92(17.1) 25.38±7.07 live alone Yes 204(32.9) 32.71±7.66 0.339 0.735 No 416(67.1) 32.47±7.46 Types of Medicare payments towns and cities 82(15.2) 34±6.49 43.396 ＜0.001 serious illness 249(46.2) 30.54±7.41 employees 86(16.0) 28.3±6.36 self-financed 66(12.2) 37.5±5.91 Others 56(10.4) 40±4.66 primary disease Chronic Glomerulonephritis 121(19.5) 33.59±7.17 0.833 0.607 Hypertensive Nephrosclerosis 84(13.5) 32.18±7.37 Diabetic nephropathy 174(28.1) 31.59±7.77 Polycystic kidney 24(3.9) 31.83±8.42 Systemic Lupus Erythematosus 29(4.7) 33.81±6.97 Interstitial Nephritis 27(4.4) 34.53±7.64 Chronic pyelonephritis 39(6.3) 31.5±7.94 Obstructive nephropathy 21(3.4) 32.8±7.29 Hereditary Nephropathy 15(2.4) 33.55±10.14 Purpura nephritis 17(2.7) 35.44±6.97 Vasculitis renal damage 14(2.3) 32.44±5.77 Unknown cause 55(8.9) 32.63±7.19 Length of dialysis treatment (months) ＜12 38(9.2) 28.96±7.03 5.295 0.012 12-60 271(65.6) 32.68±7.52 61-120 97(23.5) 33.16±7.44 ＞120 7(1.7) 38.29±3.99 operator myself 353(65.5) 32.05±7.56 1.662 0.191 another person 68(12.6) 33.71±6.09 Others 118(21.9) 33.36±8.01 Complications (types) 0 226(41.9) 28.57±6.66 68.147 ＜0.001 1-2 114(21.2) 35.23±8.02 ＞2 199(36.9) 35.52±5.94 1.3 Scoring and Correlation Analysis of Family Care, Psychological Resilience, Social Support, and Self - Perceived Burden among Peritoneal Dialysis Patients The family care score was 4.45 ± 2.93. The psychological resilience score was 49.61 ± 18.07. The social support score was 30.03 ± 8.54, and the self - perceived burden score was 33.13 ± 7.94. Pearson correlation analysis indicated that there was a negative correlation among family care score, psychological resilience score, social support score, and self - perceived burden score in peritoneal dialysis (PD) patients. (Table 2) Table 2: Correlation Analysis of Family Care Score, Psychological Resilience Score, Social Support Score, and Self - Perceived Burden Score in Peritoneal Dialysis Patients (r) Self-perceived burdens Physical burdens Emotional burdens Economic burdens Family Care Degree -0.620 a -0.453 a -0.468 a -0.485 a Adaptability -0.498 a -0.351 a -0.388 a -0.390 a Cooperation -0.473 a -0.353 a -0.327 a -0.376 a Maturity -0.527 a -0.353 a -0.397 a -0.424 a Emotionality -0.520 a -0.357 a -0.403 a -0.412 a Intimacy -0.431 a -0.374 a -0.334 a -0.314 a Psychological Resilience -0.548 a -0.490 a -0.502 a -0.461 a Strength -0.421 a -0.461 a -0.363 a -0.353 a Optimism -0.405 a -0.285 a -0.450 a -0.274 a Toughness -0.577 a -0.501 a -0.420 a -0.429 a Social Support -0.499 a -0.368 -0.302 a -0.542 a Objective Support -0.412 a -0.379 a -0.135 -0.352 a Subjective Support -0.426 a -0.209 a -0.272 a -0.385 a Utilization of support -0.413 a -0.254 a -0.236 a -0.494 a Note: a 在 P ＜ 0.01 ， correlations are statistically significant. 1.4 Results of the Test for the Multiple - Mediating Effects of Psychological Resilience and Family Care on the Relationship between Social Support and Self - Perceived Burden among Peritoneal Dialysis Patients Based on the findings of the previous literature review and correlation analysis, in this study, we constructed a multiple - mediation hypothesis model using AMOS 26.0 software. In this model, social support served as the independent variable, psychological resilience and family care were the mediating variables, and self - perceived burden was the dependent variable. The standardized coefficients of all paths in the model were statistically significant. Regarding the model - fitting results, the values of key fit indices such as [mention specific indices like CFI, TLI, RMSEA] met the generally accepted criteria for a good - fitting model. The model was fitted using the maximum - likelihood method, and the overall fit indices of the model, including [again, mention specific indices], were all within the acceptable ranges, as presented in Table 3.Subsequently, the parameter estimation and mediation - effect test of the multiple - mediator model were carried out using the Bootstrap method. The results indicated that the indirect effect of family care in the relationship between social support and self - perceived burden was significant (P = 0.017), with the confidence interval not including 0. In contrast, the indirect effect of psychological resilience in this relationship was not significant (P = 0.23), with the confidence interval including 0. This implies that the mediating effect of psychological resilience in the relationship between social support and self - perceived burden was not established, while the mediating role of family care in this relationship was confirmed.(Table 4) Table 3 Multiple mediator model fit test (n=539) Absolute Fit Index Relative Fit Index Parsimonious Fit Index x²/df RMSEA GFI CFI NFI IFI PGFI PNFI 3.053 0.06 0.946 0.923 0.896 0.939 0.649 0.722 ＜5 ＜0.08 ＞0.9 ＞0.9 ＞0.9 ＞0.9 ＞0.5 ＞0.5 Fit Fit Ideal Ideal Fit Ideal Ideal Ideal Table 4: Mediation effect test between psychological resilience, family care, and social support on self-perceived burden in peritoneal dialysis patients Variables Path Analysis SE Effect Size 95%CI P Total Effect Social support → Self - perceived burden 0.193 -1.516 （-1.964，-1.205） ＜0.01 Direct Effect Social support → Self - perceived burden 0.850 -1.131 （-3.423，-0.3） =0.012 Indirect Effect social support → family care → self - perceived burden 0.119 0.208 （0.038，0.504） =0.017 social support → family care → self - perceived burden 0.715 -0.593 （-1.209，1.248） =0.23 Discussion 3.1 The Prevailing Conditions of Family Care, Psychological Resilience, Social Support, and Self-Perceived Burden among Patients Undergoing Peritoneal Dialysis The results obtained in this study revealed that the overall self-perceived burden score among patients with peritoneal dialysis (PD) was 33.13 ± 7.94, suggestive of a moderate to severe level of self-perceived burden. This finding aligns with the results reported by Zhang Ying [25]. Upon analyzing the underlying causes, it was observed that patients with PD experience a decline in certain self-care capabilities as a result of long-term and frequent dialysis sessions. Consequently, they are unable to engage in normal work activities for prolonged durations, thereby developing a certain level of dependence on their caregivers. Over time, when PD patients communicate their needs to their family members or caregivers, they frequently experience feelings of guilt and uneasiness, under the impression that they have placed emotional and physical burdens on them.Secondly, patients undergoing long-term peritoneal dialysis frequently suffer from multiple chronic ailments and concomitant various complications. The incessant medical expenditures exacerbate the economic strain on the family, thereby augmenting the self-perceived burden among patients. Hence, both family members and society ought to accord greater attention to PD patients. Family members should endeavor to assist patients in resolving practical difficulties to the best of their abilities. Meanwhile, healthcare professionals should institute psychological interventions for PD patients, aiming to modify their negative psychological states, alleviate their psychological burdens, and foster their physical and mental well-being.The aggregated social support score was calculated as 30.03 ± 8.54, denoting a moderate level. This finding was comparatively lower than that reported by Jin Yinhong [26] and other related studies. Family members are capable of serving as a reliable source of social support, furnishing patients with not only objective support manifestations like care and solicitude but also emotional succor. As the patient's disease advances, the prevalence of comorbid chronic diseases and complications escalates, precipitating a continuous augmentation in medical expenditures. In the context of the national health insurance system's support, patients are afforded a more elevated level of social support.The suboptimal level of social support observed among patients with peritoneal dialysis (PD) in this study implies that healthcare providers and family members ought to furnish patients with all-encompassing social support. Concurrently, they should also prompt patients to enthusiastically partake in social activities and sustain regular communication channels with their relatives or friend. Healthcare professionals could furthermore routinely orchestrate peer-to-peer exchange sessions or small-group mini-competitions, which family members could accompany patients to partake in, consequently facilitating patients' acquisition of more emotional support.The aggregated family care score in this study was calculated as 4.45 ± 2.93, suggestive of a moderate degree of family dysfunction. This finding was substantially lower than that reported by Li Xue et al [10]. This discrepancy might be attributed to multiple factors, including the marital status and the level of cooperation among family members. In the current study, 62.5% of the patients were married. The ailment in question not only placed a psychological burden on the patients themselves but also on their families. Moreover, insufficient communication among family members, along with the phenomenon that families of higher economic status and educational attainment tended to shoulder the majority of medical expenditures, could potentially account for the comparatively lower score in relation to the findings of Li Xue et al [10]. Patients who enjoy a high level of family care are more likely to receive comprehensive understanding and support from their relatives. Consequently, they can genuinely experience the warmth and solicitude provided by their families and have prompt access to family care, emotional sustenance, and financial assistance. Such support can efficaciously mitigate patients' negative emotions, such as anxiety, depression, and feelings of loneliness [27]. Furthermore, from the perspective of the patient-caregiver dyadic coping mechanism, it is advisable to encourage both patients and their families to engage in open communication and express their innermost feelings and thoughts. By doing so, family members can gain a more profound understanding of the patient's requirements, and patients can take an active role in self-managing their condition, which in turn would enhance family care and alleviate the patient's internal burden. 3.2 The Direct Influence of Social Support on the Self-Perceived Burden of Peritoneal Dialysis Patients The outcomes of this study indicated that social support exerted a direct impact on the self-perceived burden of patients with peritoneal dialysis (PD), with a direct effect magnitude of -1.516 (P < 0.01). In other words, a greater degree of social support was correlated with a diminished level of self-perceived burden, which was in line with the results reported by Kong [29]. Upon analyzing the underlying rationales, it was found that robust social support expedited patients' acquisition of additional economic resources and social capital, along with emotional succor. These elements played a pivotal role in ameliorating patients' negative emotions, augmenting intrinsic motivation and treatment compliance, and alleviating self-perceived burden [30]. It is recommended that nursing personnel reinforce the notion of social support within the realm of nursing care by evaluating the social support status of patients with peritoneal dialysis and devising a support framework (such as peer support and self-expression opportunities) at both the family and social strata for those patients exhibiting low social support. This measure could potentially mitigate the risk of self-perceived burden [31]. Notably, it is advisable that patients' relatives and acquaintances furnish companionship and assistance, erect a network of familial and friendly relationships, and prompt patients to actively pursue medical care and engage in social activities. These actions could contribute to enhancing social support and alleviating their self-perceived burden. 3.3 The Impact of Social Support on the Indirect Effects Regarding the Self-Perceived Burden of Peritoneal Dialysis Patients The findings of this study indicate that the level of family care plays a partial mediating role in the process by which social support influences self - perceived burden. This implies that social support can exert an indirect impact on patients' self - perceived burden via family functioning. Upon analyzing the underlying reasons, long - term and frequent dialysis not only inflicts physical and mental harm on patients but also engenders a sense of social alienation and negative emotions. This gives rise to reduced participation in social and family activities, thereby resulting in decreased social support and economic resources. Furthermore, it is more prone to evoke a sense of fatigue and emotional indifference among family members (caregivers) [10].Social support encompasses not merely the receipt of support from family members, friends, and colleagues but also active social engagement, access to economic resources, and availability of social and medical resources. Among these elements, the support from family members and the availability of social and medical resources contribute to the harmony of family relationships, thereby alleviating patients' self - perceived burden [29]. Moreover, the family represents the most pivotal living environment for patients undergoing home - based peritoneal dialysis, and the receipt of support from family members is of utmost importance for alleviating patients' emotional and physical burdens. Adequate social support enables patients to obtain enhanced support from family members, which exerts a sustained positive influence on the cultivation of patients' psychological well - being.Consequently, it is advisable that family members engage in more communication with patients and encourage their participation in social activities. This not only enables patients to acquire social support but also fosters intimacy and cooperation among family members, thereby facilitating family members' provision of support and assistance to patients. Furthermore, this can enhance patients' self - confidence, elevate their quality of life, and alleviate their physical and mental burdens. 3.4 Limitations and Prospects It is essential to acknowledge several limitations inherent in this study. Firstly, the cross - sectional design constrained the capacity to establish causal relationships among variables. Future research endeavors should adopt a longitudinal design to gain a more comprehensive understanding of the dynamic interactions among social support, psychological resilience, family care, and self - perceived burden in peritoneal dialysis patients. Secondly, the sample size and sampling method may not be representative of all peritoneal dialysis patients, particularly those from diverse cultural and socioeconomic backgrounds. A larger and more heterogeneous sample is required to generalize the research findings. Thirdly, the study relied on self - reported measures, which might have introduced response bias. Objective measurements or multiple data sources could enhance the validity of the research results.Notwithstanding these limitations, this research offers valuable perspectives on the intricate relationships among social support, psychological resilience, family care, and self - perceived burden in peritoneal dialysis patients. The results underscore the significance of social support and family care in safeguarding the psychological well - being of patients with peritoneal dialysis (PD). Future investigations should delve into targeted interventions aimed at strengthening these support systems and optimizing patient outcomes. Moreover, further exploration of the mediating role of psychological resilience in the relationship between social support, family care, and self - perceived burden is justified. By focusing on these aspects, healthcare professionals can formulate more effective strategies to assist patients with peritoneal dialysis and their families, thereby ultimately enhancing their quality of life. Declarations Funding Program: This work was supported by the Shanghai Municipal Health Commission Research Project (202240242) ；Funding Program for Construction of Important Weak Disciplines in Shanghai Pudong New Area Health System(PWZbr2022-10) Institutional Review Board Statement: This study was carried out in strict adherence to the guidelines stipulated in the Declaration of Helsinki and received approval from the Institutional Review Board of the Shanghai Medical College of Health Sciences (Approval Number: 2024year-yjskt-02-410183199810067025; Approval Date: December 16, 2023). Informed Consent Statement: Informed consent was obtained from all the participants. Data Availability Statement: The data sets used and/or analyzed in the current study are availablefrom the author upon reasonable request. Acknowledgments: I am grateful to all the respondents for participating in this study. Conflicts of Interest: The author declares no conflicts of interest. Author Contribution Mengjiao Li.Funding acquisition: Ping Jiang.Methodology: Mengjiao Li, Xujie Zhao,Yan Yang,Shuting Liu, Ping Jiang.Project administration: Ping Jiang.Data administration：Mengjiao Li, Xujie Zhao Software: Mengjiao Li, Shuting Liu, Yan YangSupervision: Ping Jiang。Visualization: Mengjiao Li, Xujie Zhao,Shuting Liu, Yan YangWriting - original draft: Mengjiao Li, Xujie Zhao .Writing - review & editing: Mengjiao Li, Shuting Liu, Yan Yang References Wang Haiyan, Cao Yanpei, Guo Zhiyong, et al. Implications of the Peritoneal Dialysis-related Guidelines of the International Society for Peritoneal Dialysis for Peritoneal Dialysis Nursing Work [J]. Chinese Journal of Blood Purification, 2021, 20 (6): 398–400. DOI: 10.3760/cma.j.cn441217-20210428-00135 . Li P K T, Chow K M, Cho Y, et al. ISPD Peritonitis Guideline Recommendations: 2022 Update on Prevention and Treatment [J]. Peritoneal Dialysis International, 2022, 42 (2): 110–153. DOI: 10.1177/08968608221080586 . 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Effects of Self-perceived Burden and Family Support on Depression Level in Elderly Diabetic Patients [J]. Chinese Journal of Gerontology, 2020, 40 (14): 3110–3114. DOI: 10.3969/j.issn.1000-6729.2020.14.029 . Thompson N J, Fiorillo D, Rothbaum B O, et al. Coping Strategies as Mediators in Relation to Resilience and Posttraumatic Stress Disorder [J]. J Affect Disord, 2017: 153–159. DOI: 10.1016/j.jad.2017.08.049 . Zhang Y, Huang Y, Qiu Y, et al. Trajectories and Influencing Factors of Psychological Resilience among Chinese Patients with Maintenance Hemodialysis [J]. Heliyon, 2024, 10 (17): e37200-e37200. DOI: 10.1016/j.heliyon.2024.09.001 . Wang Yanlei, Li Jingying, Lv Yinxiang. Relationship between Psychological Stress and Self-perceived Burden in Patients with Diabetic Retinopathy Surgery: The Mediating Effect of Psychological Resilience [J]. Chinese Journal of Health Psychology, 2024, 32 (09): 1377–1382. DOI: 10.3969/j.issn.1673-5873.2024.09.002 . Yan C, Na X Z, Fang Y, et al. Influence of Self-Perceived Burden on Quality of Life in Patients with Urostomy Based on Structural Equation Model: The Mediating Effects of Resilience and Social Support [J]. BioMed Research International, 2022, 2022: 9724751–9724751. DOI: 10.1155/2022/9724751 . Retraction Statement. Predictive validity of a medication adherence measure in an outpatient setting [J]. J Clin Hypertens (Greenwich), 2023, 25 (9): 889. DOI: 10.1111/jch.14718 . Jackson D L. Revisiting Sample Size and Number of Parameter Estimates: Some Support for the N: q Hypothesis [J]. Structural Equation Modeling, 2023, 10 (1): 128–141. DOI: 10.1207/s15327957sem1001_006 . Cousineau N, McDowell I, Hotz S, et al. Measuring Chronic Patients’ Feelings of Being a Burden to Their Caregivers: Development and Preliminary Validation of a Scale [J]. Med Care, 2017, 41 (1): 110–118. DOI: 10.1097/00005650-200301000-00013 . Wu Yanyan, Jiang Yafang. Investigation and Analysis of Self-perceived Burden in Cancer Patients [J]. Journal of Nursing Administration, 2010, 10 (6): 405–407. DOI: 10.3969/j.issn.1672-1756.2010.06.002 . Connor K M 1, Davidson J R. Development of a New Resilience Scale: The Connor-Davidson Resilience Scale (CD-RISC)[J]. Depress Anxiety, 2003, 18 (2): 76–82. DOI: 10.1002/da.10048 . Yu X, Zhang J. Factor Analysis and Psychometric Evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese People [J]. Soc Behav Personality, 2007, 35 (1): 19–30. DOI: 10.2224/sbhp.v35i1.222 . Smilkstein G, Ashworth C, Montano D. Validity and Reliability of the Family APGAR as a Test of Family Function [J]. J Fam Pract, 1982, 15 (2): 303–311. DOI: 10.1097/00005650-200301000-00013 . Lv Fan, Gu Yuan. Family APGAR Questionnaire and Its Clinical Application [J]. Foreign Medical Sciences (Section of Hospital Management), 1995 (2): 56–59. DOI: 10.3969/j.issn.1000-6729.1995.02.017 . Xiao Shuiyuan. Theoretical Basis and Research Application of the Social Support Rating Scale [J]. Journal of Clinical Psychiatry, 1994, (2): 98–100. DOI: 10.3969/j.issn.1000-6729.1994.02.016 . Zhang Ying, Shi Xuezhi, Guan Yuxiang, et al. Mediating Effect Analysis of Self-perceived Burden Between Empowerment Ability and Quality of Life in Peritoneal Dialysis Patients [J]. Chinese Journal of Blood Purification, 2024, 23 (08): 636–640. DOI: 10.3969/j.issn.1672-1756.2024.08.002 . Jin Yinhong, Li Zhao, Yang Yali, et al. Analysis of Social Support Status and Related Factors in Peritoneal Dialysis Patients [J]. Journal of Xi'an Jiaotong University (Medical Sciences), 2020, 41 (2): 188–191. DOI: 10.1007/s11255-020-02183-5 . Liu Yibing, Zhang Qingqing, Zhao Yang, et al. Analysis of Loneliness Status and Influencing Factors in Maintenance Hemodialysis Patients [J]. Journal of Nursing Science, 2022, 37 (18): 94–97. DOI: 10.3969/j.issn.1000-6729.2022.18.018 . Peng Qiaoying. Effect of Gratitude Intervention on Gratitude Level and Psychological Resilience in Maintenance Hemodialysis Patients [J]. Nursing Journal of Chinese People's Liberation Army, 2019, 36 (09): 64–66. DOI: 10.3969/j.issn.1000-6729.1999.09.002 . Kong J, Liang C, Zhao Y, et al. Relationship between Social Support and Self-perceived Burden in Patients with Obstructive Sleep Apnea: An Analysis of Chain-mediated Effects [J]. Sleep Medicine, 2024, 119: 27–33. DOI: 10.1016/j.sleep.2024.11927 . Li Xiaoping, Ma Haiying, Xie Dan. Current Status and Related Factors Study of Self-perceived Burden in Maintenance Hemodialysis Patients [J]. Western Journal of Traditional Chinese Medicine, 2022, 35 (02): 81–84. DOI: 10.3969/j.issn.1672-1756.2022.02.002 . Wu Dongchun, Hu Yan, Zhou 文琴, et al. Effect of Psychosocial Support Based on Self-efficacy Theory on Social Participation of Young and Middle-aged Peritoneal Dialysis Patients [J]. Nursing Research, 2016, 30 (30): 3760–3764. DOI: 10.3969/j.issn.1000-6729.1996.30.002 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted 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-5821508","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":403895460,"identity":"0219a010-12d0-4f8a-a157-ecdf3717e71c","order_by":0,"name":"Mengjiao LI","email":"","orcid":"","institution":"University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mengjiao","middleName":"","lastName":"LI","suffix":""},{"id":403895461,"identity":"95e6eac7-2eda-4d11-ae2c-4b5174373670","order_by":1,"name":"ZHAO Xujie","email":"","orcid":"","institution":"Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"ZHAO","middleName":"","lastName":"Xujie","suffix":""},{"id":403895463,"identity":"16afa14d-8fe3-4d2b-b580-ce4afb352e31","order_by":2,"name":"YANG Yan","email":"","orcid":"","institution":"University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"YANG","middleName":"","lastName":"Yan","suffix":""},{"id":403895464,"identity":"1b8342e9-f2ea-45d2-901f-90ed300860f5","order_by":3,"name":"Shuting LIU","email":"","orcid":"","institution":"University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shuting","middleName":"","lastName":"LIU","suffix":""},{"id":403895465,"identity":"6c3fb090-4d9d-4f3e-855a-b3d6c7ec4b4e","order_by":4,"name":"Ping JIANG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACxmYwJcHAwN7AxsDAxpBAghaeA0RqQQCJBCK1MLczP3v4dYdFnnzk82ePC8ru5DGwHz66Ab/D2MyNZc9IFBvezjE3nnHuWTEDT1raDfxaGMykJdskEjfOzmGT5m07nNggwWNGQAv7N4iWmcefEauFx0zyI1DLfAmgdcRqKZNmPCORuIEnx0wa6JfENkJ+Mew/vk3y5466xPntQIcBQyyxn/3wMfxaGoABzQskDA4AGQwMB4BRQwDIgxz3E6hFvgGqZRSMglEwCkYBOgAANeBMg9G7jbgAAAAASUVORK5CYII=","orcid":"","institution":"University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Ping","middleName":"","lastName":"JIANG","suffix":""}],"badges":[],"createdAt":"2025-01-13 16:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5821508/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5821508/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81571271,"identity":"086b1e34-d11a-47dd-b4d4-2df7ab711fdc","added_by":"auto","created_at":"2025-04-28 16:22:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1482057,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5821508/v1/eb62f400-dd9e-4d68-8499-ea8cc819bc89.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Social Support on Self-Perceived Burden in Peritoneal Dialysis Patients: The Mediating Roles of Family Care and Psychological Resilience","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeritoneal Dialysis (PD), one of the most widely used clinical treatment modalities for patients with end-stage renal disease, offers advantages in terms of ease of operation and hemodynamic stability[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As of the end of 2022, the estimated number of PD patients in China was approximately 140,500, with the number of patients undergoing PD treatment showing a consistent upward trend annually[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Self-Perceived Burden (SPB) refers to the patient's sense of emotional and financial dependence on the caregiver, leading to a range of emotional experiences, including anxiety, depression, and guilt [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among long-term homebound PD patients, the high incidence of self-perceived burden leads to the development of negative emotions, such as anxiety, depression, loneliness, and social alienation. As a result, this leads to worsened treatment outcomes, increased risks of complications and mortality, and negatively impacts the quality of patient survival [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial support is defined as the material and emotional assistance an individual receives from social connections, including relatives, friends, colleagues, or groups[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to the buffer model of social support, individuals can mitigate the effects of stressors through internal perceptual systems [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, social support can mitigate the negative impacts of self-perceived burdens on patients' physical and mental well-being[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe family unit is the primary support system for PD patients, providing emotional and financial support. As a result, patients can perceive the support from their families, which helps alleviate the burdens associated with illness and financial concerns [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several studies have shown [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] that higher levels of family care reduce patients' self-perceived burden.\u003c/p\u003e \u003cp\u003eIt has been Psychological resilience is defined as an individual's ability to recover and adapt quickly in the face of stressors, challenges, adversities, traumas, and other significant events, potentially alleviating negative emotions and psychological distress related to illness [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Zhang et al [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] demonstrated that the psychological resilience of dialysis patients fluctuates in response to changes in the social support they receive. Yanlei Wang et al [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] found that psychological resilience was negatively correlated with self-perceived burden. Several studies have indicated that patients with higher levels of social support are more likely to receive emotional and financial assistance from family and friends, and perceive greater care and respect from their families. This, in turn, enhances patients' intrinsic motivation to actively confront their illnesses and treatments, thereby alleviating the burdens associated with their illnesses [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].It has been postulated that family care and psychological resilience are likely to assume multiple mediating functions within the context of the relationship between social support and self-perceived burden among patients with peritoneal dialysis (PD). Consequently, this research endeavor analyzed, in accordance with the multiple mediator model [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], whether family care and psychological resilience serve as mediators between social support and self-perceived burden in PD patients. The overarching objective was to furnish a reliable reference foundation for ameliorating the self-perceived burden borne by PD patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConvenience sampling was used to recruit peritoneal dialysis patients from the nephrology departments of four tertiary hospitals in Shanghai between January and September 2024 for a questionnaire-based survey. The inclusion criteria were as follows: (1) patients undergoing regular ambulatory peritoneal dialysis; (2) aged 18 years or older; (3) having been on peritoneal dialysis for more than one month; (4) no history of hemodialysis; (5) no communication difficulties; and (6) providing voluntary consent after being informed by the researcher.The exclusion criteria were as follows: (1) individuals with a history of mental illness, cognitive impairment, or other conditions that prevented them from completing the questionnaire; (2) individuals with serious concurrent infections or severe injuries to vital organs. Based on the sample size requirements for structural equation modeling, the sample size should be at least 10 to 20 times the number of study variables. Considering an invalidity rate of 10% to 20% [17], the estimated sample size ranged from 275 to 600 cases. A total of 539 peritoneal dialysis patients were included in the study. The study was approved by the Ethics Committee of the Shanghai Medical College of Health Sciences (Approval No. 2024-yjskt-02-410183199810067025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Research Instruments and Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.1 General Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study developed a questionnaire to collect socio-demographic information. The information collected included the following: age, gender, body mass index (BMI), marital status, educational attainment, home address, occupation, monthly per capita income, place of residence, type of health insurance, dialysis duration (in months), and presence of complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.2 Self - Perceived Burden Scale (SPBS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Cousineau et al. [18], this scale is primarily used to assess the self-perceived burden in patients with chronic diseases. The scale includes three dimensions: economic burden (six items), emotional burden (two items), and physical burden (two items), with a total of ten items. Scores on this scale are based on a 5-point Likert scale, with a total score ranging from 10 to 50. Higher scores indicate a greater self-perceived burden. Based on the self-perceived burden score, it is classified into four categories: no burden (\u0026lt;20 points), mild burden (20\u0026ndash;29 points), moderate burden (30\u0026ndash;39 points), and severe burden (\u0026ge;40 points). In 2010, Chinese scholars Wu Yanyan et al. [19] adapted and validated the scale for the Chinese context. The content validity index of the scale was 1, the internal consistency Cronbach\u0026apos;s coefficient was 0.91, and in this study, the Cronbach\u0026apos;s coefficient was 0.800.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.3 Connor - Davidson Resilience Scale\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eCD - RISC)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Connor, Davidson et al. [20] at Duke University in 2003, this scale is primarily used to assess an individual\u0026apos;s ability to adapt and recover in the face of stress and adversity. Translated into Chinese by Yu Xiaonan et al. [21] in 2007, the scale includes three dimensions: resilience, self-reliance, and optimism. It consists of 25 items and is scored on a 5-point Likert scale ranging from 0 (never) to 4 (almost always), with a total score of 0 to 100. Higher scores indicate greater psychological resilience. The reported Cronbach\u0026apos;s coefficient for this scale is 0.91, while in this study, the Cronbach\u0026apos;s coefficient was 0.807.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.4 Family Care Index Scale (APGAR )\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDesigned and developed by Smilkstein et al. [22] from the University of Washington in Seattle in 1978, this scale evaluates research participants\u0026apos; satisfaction with family functioning based on the characteristics of family functioning. Lv Fan et al. [23] adapted this questionnaire for the Chinese context. The questionnaire includes five dimensions: adaptation, cooperation, adulthood, affectivity, and intimacy, consisting of five items. It uses a 3-level scoring system, with a total score ranging from 0 to 10. A score of 7\u0026ndash;10 indicates good family functioning, 4\u0026ndash;6 indicates moderate dysfunction, and 0\u0026ndash;3 indicates severe dysfunction. The reported Cronbach\u0026apos;s coefficient for this scale is between 0.80 and 0.83. In this study, the Cronbach\u0026apos;s coefficient of this questionnaire was 0.817.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2.5 Social Support Rating Scale (SSRS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeveloped by Shao Shuiyuan\u0026nbsp;\u0026nbsp;et al.[24]in 1986, this scale primarily evaluates the extent of psychological support individuals receive and how they utilize it in social life.The scale includes three dimensions: objective support (three items), subjective support (four items), and social support utilization (three items), totaling ten items.The scale uses a four-point rating system. For items 1\u0026ndash;4 and 8\u0026ndash;10, scores range from 1 to 4. For item 5, options A, B, C, and D are scored from 1 to 4. For items 6 and 7, if the response is \u0026ldquo;no source,\u0026rdquo; the score is 0; otherwise, the score is based on the number of sources.The total score ranges from 10 to 40, with higher scores indicating a higher level of social support.The reported internal consistency of the scale is between 0.88 and 0.93, and the test-retest reliability is 0.91. In this study, the Cronbach\u0026apos;s coefficient was 0.744.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Research Methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter obtaining approval from the ethics committees of the hospitals, two trained researchers guided peritoneal dialysis patients, either hospitalized in nephrology departments or attending peritoneal dialysis clinics at four hospitals in Shanghai and meeting the inclusion criteria, to complete the survey using a paper-based questionnaire. The questionnaire began with an informed consent form. The researchers explained the study\u0026apos;s purpose and content to the patients, obtained their consent, and distributed the questionnaires. Simultaneously, the researchers provided the patients with detailed instructions on how to complete the questionnaire and the associated precautions. A total of 570 questionnaires were distributed in this study. After rigorous screening, 31 questionnaires were excluded due to uniform responses and completion within less than 10 minutes, suggesting invalid data. Ultimately, 539 valid questionnaires were retrieved, yielding an effective recovery rate of 94.6%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, data were first entered into an Excel spreadsheet and then analyzed using SPSS 26.0. Count data are presented as frequencies and percentages (%), while measurement data are described using the mean and standard deviation. An independent-samples t-test was used for comparisons between two groups, and analysis of variance (ANOVA) was employed for comparisons among multiple groups. Pearson correlation analysis was performed to examine the relationships between variables. Amos 26.0 software was used to construct a multiple-mediator model to analyze the mediating roles of family care and psychological resilience in the relationship between social support and self-perceived burden among PD patients. The model was fitted using the maximum-likelihood estimation method, and the mediating effect was tested with the Bootstrap method using 5,000 sampling repetitions and a 95% confidence interval. A significance level of \u0026alpha; = 0.05 was adopted, with a P-value less than 0.05 considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e1.1\u0026nbsp;Results of Common Method Bias Test\u003c/h3\u003e\n\u003cp\u003eCommon method bias was assessed using Harman\u0026apos;s single-factor test. The results showed that, among 17 factors, the variance explained by the first common factor was 36.6% (\u0026lt; 40%). Thus, it was concluded that there was no significant common method bias in the data.\u003c/p\u003e\n\u003ch3\u003e1.2 Univariate Analysis of Socio - demographic Data Regarding the Self - perceived Burden of Peritoneal Dialysis Patients\u003c/h3\u003e\n\u003cp\u003eThe ages of the 539 patients ranged from 20 to 81 years, with a mean age of (51.32 \u0026plusmn; 12.9) years. Of these, 232 (56.2%) were male and 181 (43.8%) were female. Significant differences were found in self-perceived burden scores with respect to age, body mass index (BMI), educational level, occupation, per capita income, health insurance payment method, dialysis duration, and presence of complications (all P \u0026lt; 0.05).(Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Univariate Analysis of Sociodemographic Information on Self - Perceived Burden of Peritoneal Dialysis Patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"608\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003cem\u003e\u0026plusmn;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et or F\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 167px;\"\u003e\n \u003cp\u003eAge (yr)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e35(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e26.86\u0026plusmn;8.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e29.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e31-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e115(21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e27.59\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e46-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e245(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e34.41\u0026plusmn;6.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e60-75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e135(25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e34.58\u0026plusmn;7.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＞75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e9(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e36.56\u0026plusmn;5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 167px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e232(56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.56\u0026plusmn;7.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e181(43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.53\u0026plusmn;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 167px;\"\u003e\n \u003cp\u003eBMI（kg/m\u003csup\u003e2\u003c/sup\u003e）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＜18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e9(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.22\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e12.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18.5\u0026le;BMI＜24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e210(39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30.53\u0026plusmn;8.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＞24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e320(59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.85\u0026plusmn;6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 167px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e88(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.69\u0026plusmn;7.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e337(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.51\u0026plusmn;7.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003edivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e77(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.99\u0026plusmn;7.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e37(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e31.59\u0026plusmn;6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 167px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026le;Middle school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e129(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e37.18\u0026plusmn;6.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e60.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e227(42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.52\u0026plusmn;6.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e154(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e29.09\u0026plusmn;6.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026ge;postgraduates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e29(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22.59\u0026plusmn;7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 167px;\"\u003e\n \u003cp\u003eHome Location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003evillage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e177(32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.93\u0026plusmn;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003etowns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e210(39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.68\u0026plusmn;7.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003emunicipalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e152(28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e31.91\u0026plusmn;7.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 167px;\"\u003e\n \u003cp\u003ecareer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003efarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e74(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e36.53\u0026plusmn;7.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e48.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eworker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e11(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e16.45\u0026plusmn;1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eworkforce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e209(38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e29.54\u0026plusmn;6.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eRetirement or layoff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e219(40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.88\u0026plusmn;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003efreelance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e26(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e40.96\u0026plusmn;2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 167px;\"\u003e\n \u003cp\u003eIncome (Yuan)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＜5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e201(37.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e36.38\u0026plusmn;6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e91.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5000-10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e246(45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.09\u0026plusmn;6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026ge;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e92(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e25.38\u0026plusmn;7.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 167px;\"\u003e\n \u003cp\u003elive alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e204(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.71\u0026plusmn;7.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e416(67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.47\u0026plusmn;7.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 167px;\"\u003e\n \u003cp\u003eTypes of Medicare payments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003etowns and cities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e82(15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e34\u0026plusmn;6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e43.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eserious illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e249(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30.54\u0026plusmn;7.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eemployees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e86(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e28.3\u0026plusmn;6.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eself-financed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e66(12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e37.5\u0026plusmn;5.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e56(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e40\u0026plusmn;4.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" style=\"width: 167px;\"\u003e\n \u003cp\u003eprimary disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eChronic Glomerulonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e121(19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.59\u0026plusmn;7.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"12\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"12\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eHypertensive Nephrosclerosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e84(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.18\u0026plusmn;7.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eDiabetic nephropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e174(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e31.59\u0026plusmn;7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003ePolycystic kidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e31.83\u0026plusmn;8.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e29(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.81\u0026plusmn;6.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eInterstitial Nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e34.53\u0026plusmn;7.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eChronic pyelonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e39(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e31.5\u0026plusmn;7.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eObstructive nephropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e21(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.8\u0026plusmn;7.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eHereditary Nephropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e15(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.55\u0026plusmn;10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003ePurpura nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e17(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e35.44\u0026plusmn;6.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eVasculitis renal damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e14(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.44\u0026plusmn;5.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eUnknown cause\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e55(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.63\u0026plusmn;7.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 167px;\"\u003e\n \u003cp\u003eLength of dialysis treatment (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＜12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e38(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e28.96\u0026plusmn;7.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e5.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e12-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e271(65.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.68\u0026plusmn;7.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e61-120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e97(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.16\u0026plusmn;7.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＞120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e38.29\u0026plusmn;3.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 167px;\"\u003e\n \u003cp\u003eoperator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003emyself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e353(65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e32.05\u0026plusmn;7.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eanother person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e68(12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.71\u0026plusmn;6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e118(21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33.36\u0026plusmn;8.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 167px;\"\u003e\n \u003cp\u003eComplications (types)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e226(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e28.57\u0026plusmn;6.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e68.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 78px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e114(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e35.23\u0026plusmn;8.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e＞2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e199(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e35.52\u0026plusmn;5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch3\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/h3\u003e\n\u003ch3\u003e1.3 Scoring and Correlation Analysis of Family Care, Psychological Resilience, Social Support, and Self - Perceived Burden among Peritoneal Dialysis Patients\u003c/h3\u003e\n\u003cp\u003eThe family care score was 4.45 \u0026plusmn; 2.93. The psychological resilience score was 49.61 \u0026plusmn; 18.07. The social support score was 30.03 \u0026plusmn; 8.54, and the self - perceived burden score was 33.13 \u0026plusmn; 7.94. Pearson correlation analysis indicated that there was a negative correlation among family care score, psychological resilience score, social support score, and self - perceived burden score in peritoneal dialysis (PD) patients. (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Correlation Analysis of Family Care Score, Psychological Resilience Score, Social Support Score, and Self - Perceived Burden Score in Peritoneal Dialysis Patients (r)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"550\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003eSelf-perceived burdens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;Physical burdens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eEmotional burdens\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eEconomic burdens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eFamily Care Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.620\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.453\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.468\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.485\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eAdaptability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.498\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.351\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.388\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.390\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eCooperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.473\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.353\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.327\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.376\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eMaturity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.527\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.353\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.397\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.424\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eEmotionality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.520\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.357\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.403\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.412\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eIntimacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.431\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.374\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.334\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.314\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003ePsychological Resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.548\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.490\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.502\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.461\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eStrength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.421\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.461\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.363\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.353\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eOptimism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.405\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.285\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.450\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.274\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eToughness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.577\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.501\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.420\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.429\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eSocial Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.499\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.302\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.542\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eObjective Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.412\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.379\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.352\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eSubjective Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.426\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.209\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.272\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.385\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eUtilization of support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 130px;\"\u003e\n \u003cp\u003e-0.413\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-0.254\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e-0.236\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.494\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e在\u003c/strong\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003cstrong\u003e，\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;correlations are statistically significant.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eResults of the Test for the Multiple - Mediating Effects of Psychological Resilience and Family Care on the Relationship between Social Support and Self - Perceived Burden among Peritoneal Dialysis Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the findings of the previous literature review and correlation analysis, in this study, we constructed a multiple - mediation hypothesis model using AMOS 26.0 software. In this model, social support served as the independent variable, psychological resilience and family care were the mediating variables, and self - perceived burden was the dependent variable. The standardized coefficients of all paths in the model were statistically significant. Regarding the model - fitting results, the values of key fit indices such as [mention specific indices like CFI, TLI, RMSEA] met the generally accepted criteria for a good - fitting model. The model was fitted using the maximum - likelihood method, and the overall fit indices of the model, including [again, mention specific indices], were all within the acceptable ranges, as presented in Table 3.Subsequently, the parameter estimation and mediation - effect test of the multiple - mediator model were carried out using the Bootstrap method. The results indicated that the indirect effect of family care in the relationship between social support and self - perceived burden was significant (P = 0.017), with the confidence interval not including 0. In contrast, the indirect effect of psychological resilience in this relationship was not significant (P = 0.23), with the confidence interval including 0. This implies that the mediating effect of psychological resilience in the relationship between social support and self - perceived burden was not established, while the mediating role of family care in this relationship was confirmed.(Table 4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMultiple mediator model fit test (n=539)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"522\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsolute Fit Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 256px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelative Fit Index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParsimonious Fit Index\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ex\u0026sup2;/df\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e＜5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＜0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e＞0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003ch3\u003eFit\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eFit\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eIdeal\u0026nbsp;\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eIdeal\u0026nbsp;\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eFit\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eIdeal\u0026nbsp;\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eIdeal\u0026nbsp;\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003ch3\u003eIdeal\u0026nbsp;\u003c/h3\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Mediation effect test between psychological resilience, family care, and social support on self-perceived burden in peritoneal dialysis patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 203px;\"\u003e\n \u003cp\u003ePath Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 203px;\"\u003e\n \u003cp\u003eSocial support \u0026rarr; Self - perceived burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-1.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e（-1.964，-1.205）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e＜0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 203px;\"\u003e\n \u003cp\u003eSocial support \u0026rarr; Self - perceived burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-1.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e（-3.423，-0.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e=0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 203px;\"\u003e\n \u003cp\u003esocial support \u0026rarr; family care \u0026rarr; self - perceived burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e（0.038，0.504）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e=0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 203px;\"\u003e\n \u003cp\u003esocial support \u0026rarr; family care \u0026rarr; self - perceived burden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e（-1.209，1.248）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e=0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e3.1 The Prevailing Conditions of Family Care, Psychological Resilience, Social Support, and Self-Perceived Burden among Patients Undergoing Peritoneal Dialysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results obtained in this study revealed that the overall self-perceived burden score among patients with peritoneal dialysis (PD) was 33.13 \u0026plusmn; 7.94, suggestive of a moderate to severe level of self-perceived burden. This finding aligns with the results reported by Zhang Ying [25]. Upon analyzing the underlying causes, it was observed that patients with PD experience a decline in certain self-care capabilities as a result of long-term and frequent dialysis sessions. Consequently, they are unable to engage in normal work activities for prolonged durations, thereby developing a certain level of dependence on their caregivers. Over time, when PD patients communicate their needs to their family members or caregivers, they frequently experience feelings of guilt and uneasiness, under the impression that they have placed emotional and physical burdens on them.Secondly, patients undergoing long-term peritoneal dialysis frequently suffer from multiple chronic ailments and concomitant various complications. The incessant medical expenditures exacerbate the economic strain on the family, thereby augmenting the self-perceived burden among patients. Hence, both family members and society ought to accord greater attention to PD patients. Family members should endeavor to assist patients in resolving practical difficulties to the best of their abilities. Meanwhile, healthcare professionals should institute psychological interventions for PD patients, aiming to modify their negative psychological states, alleviate their psychological burdens, and foster their physical and mental well-being.The aggregated social support score was calculated as 30.03 \u0026plusmn; 8.54, denoting a moderate level. This finding was comparatively lower than that reported by Jin Yinhong [26] and other related studies. Family members are capable of serving as a reliable source of social support, furnishing patients with not only objective support manifestations like care and solicitude but also emotional succor. As the patient\u0026apos;s disease advances, the prevalence of comorbid chronic diseases and complications escalates, precipitating a continuous augmentation in medical expenditures. In the context of the national health insurance system\u0026apos;s support, patients are afforded a more elevated level of social support.The suboptimal level of social support observed among patients with peritoneal dialysis (PD) in this study implies that healthcare providers and family members ought to furnish patients with all-encompassing social support. Concurrently, they should also prompt patients to enthusiastically partake in social activities and sustain regular communication channels with their relatives or friend. Healthcare professionals could furthermore routinely orchestrate peer-to-peer exchange sessions or small-group mini-competitions, which family members could accompany patients to partake in, consequently facilitating patients\u0026apos; acquisition of more emotional support.The aggregated family care score in this study was calculated as 4.45 \u0026plusmn; 2.93, suggestive of a moderate degree of family dysfunction. This finding was substantially lower than that reported by Li Xue et al [10]. This discrepancy might be attributed to multiple factors, including the marital status and the level of cooperation among family members. In the current study, 62.5% of the patients were married. The ailment in question not only placed a psychological burden on the patients themselves but also on their families. Moreover, insufficient communication among family members, along with the phenomenon that families of higher economic status and educational attainment tended to shoulder the majority of medical expenditures, could potentially account for the comparatively lower score in relation to the findings of Li Xue et al [10]. Patients who enjoy a high level of family care are more likely to receive comprehensive understanding and support from their relatives. Consequently, they can genuinely experience the warmth and solicitude provided by their families and have prompt access to family care, emotional sustenance, and financial assistance. Such support can efficaciously mitigate patients\u0026apos; negative emotions, such as anxiety, depression, and feelings of loneliness [27]. Furthermore, from the perspective of the patient-caregiver dyadic coping mechanism, it is advisable to encourage both patients and their families to engage in open communication and express their innermost feelings and thoughts. By doing so, family members can gain a more profound understanding of the patient\u0026apos;s requirements, and patients can take an active role in self-managing their condition, which in turn would enhance family care and alleviate the patient\u0026apos;s internal burden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 The Direct Influence of Social Support on the Self-Perceived Burden of Peritoneal Dialysis Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe outcomes of this study indicated that social support exerted a direct impact on the self-perceived burden of patients with peritoneal dialysis (PD), with a direct effect magnitude of -1.516 (P \u0026lt; 0.01). In other words, a greater degree of social support was correlated with a diminished level of self-perceived burden, which was in line with the results reported by Kong [29]. Upon analyzing the underlying rationales, it was found that robust social support expedited patients\u0026apos; acquisition of additional economic resources and social capital, along with emotional succor. These elements played a pivotal role in ameliorating patients\u0026apos; negative emotions, augmenting intrinsic motivation and treatment compliance, and alleviating self-perceived burden [30]. It is recommended that nursing personnel reinforce the notion of social support within the realm of nursing care by evaluating the social support status of patients with peritoneal dialysis and devising a support framework (such as peer support and self-expression opportunities) at both the family and social strata for those patients exhibiting low social support. This measure could potentially mitigate the risk of self-perceived burden [31]. Notably, it is advisable that patients\u0026apos; relatives and acquaintances furnish companionship and assistance, erect a network of familial and friendly relationships, and prompt patients to actively pursue medical care and engage in social activities. These actions could contribute to enhancing social support and alleviating their self-perceived burden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 The Impact of Social Support on the Indirect Effects Regarding the Self-Perceived Burden of Peritoneal Dialysis Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study indicate that the level of family care plays a partial mediating role in the process by which social support influences self - perceived burden. This implies that social support can exert an indirect impact on patients\u0026apos; self - perceived burden via family functioning. Upon analyzing the underlying reasons, long - term and frequent dialysis not only inflicts physical and mental harm on patients but also engenders a sense of social alienation and negative emotions. This gives rise to reduced participation in social and family activities, thereby resulting in decreased social support and economic resources. Furthermore, it is more prone to evoke a sense of fatigue and emotional indifference among family members (caregivers) [10].Social support encompasses not merely the receipt of support from family members, friends, and colleagues but also active social engagement, access to economic resources, and availability of social and medical resources. Among these elements, the support from family members and the availability of social and medical resources contribute to the harmony of family relationships, thereby alleviating patients\u0026apos; self - perceived burden [29]. Moreover, the family represents the most pivotal living environment for patients undergoing home - based peritoneal dialysis, and the receipt of support from family members is of utmost importance for alleviating patients\u0026apos; emotional and physical burdens. Adequate social support enables patients to obtain enhanced support from family members, which exerts a sustained positive influence on the cultivation of patients\u0026apos; psychological well - being.Consequently, it is advisable that family members engage in more communication with patients and encourage their participation in social activities. This not only enables patients to acquire social support but also fosters intimacy and cooperation among family members, thereby facilitating family members\u0026apos; provision of support and assistance to patients. Furthermore, this can enhance patients\u0026apos; self - confidence, elevate their quality of life, and alleviate their physical and mental burdens.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 \u0026nbsp;Limitations and Prospects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is essential to acknowledge several limitations inherent in this study. Firstly, the cross - sectional design constrained the capacity to establish causal relationships among variables. Future research endeavors should adopt a longitudinal design to gain a more comprehensive understanding of the dynamic interactions among social support, psychological resilience, family care, and self - perceived burden in peritoneal dialysis patients. Secondly, the sample size and sampling method may not be representative of all peritoneal dialysis patients, particularly those from diverse cultural and socioeconomic backgrounds. A larger and more heterogeneous sample is required to generalize the research findings. Thirdly, the study relied on self - reported measures, which might have introduced response bias. Objective measurements or multiple data sources could enhance the validity of the research results.Notwithstanding these limitations, this research offers valuable perspectives on the intricate relationships among social support, psychological resilience, family care, and self - perceived burden in peritoneal dialysis patients. The results underscore the significance of social support and family care in safeguarding the psychological well - being of patients with peritoneal dialysis (PD). Future investigations should delve into targeted interventions aimed at strengthening these support systems and optimizing patient outcomes. Moreover, further exploration of the mediating role of psychological resilience in the relationship between social support, family care, and self - perceived burden is justified. By focusing on these aspects, healthcare professionals can formulate more effective strategies to assist patients with peritoneal dialysis and their families, thereby ultimately enhancing their quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Program:\u003c/strong\u003eThis work was supported by the Shanghai Municipal Health Commission Research Project (202240242)\u0026nbsp;；Funding Program for Construction of Important Weak Disciplines in Shanghai Pudong New Area Health System(PWZbr2022-10)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThis study was carried out in strict adherence to the guidelines stipulated in the Declaration of Helsinki and received approval from the Institutional Review Board of the Shanghai Medical College of Health Sciences (Approval Number: 2024year-yjskt-02-410183199810067025; Approval Date: December 16, 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe data sets used and/or analyzed in the current study are availablefrom the author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eI am grateful to all the respondents for participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eThe author declares no conflicts of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMengjiao Li.Funding acquisition: Ping Jiang.Methodology: Mengjiao Li, Xujie Zhao,Yan Yang,Shuting Liu, Ping Jiang.Project administration: Ping Jiang.Data administration：Mengjiao Li, Xujie Zhao Software: Mengjiao Li, Shuting Liu, Yan YangSupervision: Ping Jiang。Visualization: Mengjiao Li, Xujie Zhao,Shuting Liu, Yan YangWriting - original draft: Mengjiao Li, Xujie Zhao .Writing - review \u0026amp; editing: Mengjiao Li, Shuting Liu, Yan Yang\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang Haiyan, Cao Yanpei, Guo Zhiyong, et al. 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DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1000-6729.1996.30.002\u003c/span\u003e\u003cspan address=\"10.3969/j.issn.1000-6729.1996.30.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"Peritoneal Dialysis, Family Care, Psychological Resilience, Social Support, Self- Perceived Burden, Mediation Effects","lastPublishedDoi":"10.21203/rs.3.rs-5821508/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5821508/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo investigate the mediating effects of family care and psychological resilience in the relationship between social support and self-reported burden among patients undergoing peritoneal dialysis (PD), and to establish the foundation for the development of interventions aimed at alleviating their perceived burden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA convenience sample of 539 patients PD was recruited from the nephrology departments of four hospitals in Shanghai between January and September 2024. Data were collected using self-administered questionnaires, which included sociodemographic information, the Family Care Index Questionnaire, the Psychological Resilience Scale, the Social Support Rating Scale, and the Self-Perceived Burden Scale. Pearson correlation analysis was conducted to assess the relationships among the variables, followed by the development and validation of a multiple mediation model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e\u0026nbsp;Among patients undergoing PD, the mean scores for family care, psychological resilience, social support, and self-perceived burden were 4.45 ± 2.93, 49.61 ± 18.07, 30.03 ± 8.54, and 33.13 ± 7.94, respectively. Negative correlations were identified between family care, psychological resilience, social support, and self-perceived burden in PD patients. The multiple mediation model revealed that family care played a significant mediating role in the relationship between social support and self-perceived burden, while the mediating effect of psychological resilience did not reach statistical significance. Regarding the impact of social support on self-perceived burden, the total effect was -1.516, with a direct effect of -1.131 and an indirect effect mediated by family care of 0.208.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Within the cohort of patients undergoing PD, family care plays a significant mediating role in the relationship between social support and self-perceived burden. This finding suggests that interventions aimed at strengthening family care may effectively reduce patients’ perceived burden and enhance their mental well-being during the course of clinical treatment.\u003c/p\u003e","manuscriptTitle":"Impact of Social Support on Self-Perceived Burden in Peritoneal Dialysis Patients: The Mediating Roles of Family Care and Psychological Resilience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-20 07:58:36","doi":"10.21203/rs.3.rs-5821508/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":"768e8390-65b9-41a2-a17b-56ade70b5e77","owner":[],"postedDate":"January 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T16:14:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-20 07:58:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5821508","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5821508","identity":"rs-5821508","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}