Abstract
BACKGROUND: The proportion of young and middle-aged patients undergoing maintenance hemodialysis (MHD) has increased in recent years. Due to the physical and psychological impacts of the disease, MHD patients are prone to existential distress, which can lead to anxiety, depression, and other psychological issues. This not only severely impairs their quality of life but also imposes a heavy burden on families and society. OBJECTIVE: To explore the mediating role of self-disclosure between intolerance of uncertainty and existential distress in young and middle-aged MHD patients, and to provide intervention targets for reducing existential distress in this population. METHODS: From January 2024 to October 2024, 342 MHD patients treated in the Hemodialysis Center of a tertiary grade A hospital in Nanchong were selected using convenience sampling. A general information questionnaire, the Intolerance of Uncertainty Scale (IUS), the Self-Disclosure Index (SDI), and the Existential Distress Scale (EDS) were used for data collection. RESULTS: The scores of self-disclosure, intolerance of uncertainty, and existential distress in young and middle-aged MHD patients were (38.08 ± 5.97), (45.44 ± 6.10), and (34.39 ± 7.72), respectively. Significant differences in intolerance of uncertainty scores were observed among patients with different genders, age groups, dialysis durations, marital statuses, educational levels, and employment statuses (all p < 0.05). Similarly, self-disclosure scores differed significantly by gender, age group, dialysis duration, educational level, and employment status (all p < 0.05), and existential distress scores varied significantly by gender, age group, dialysis duration, marital status, educational level, and employment status (all p < 0.05). Intolerance of uncertainty was negatively correlated with self-disclosure (r = -0.766, p < 0.01), positively correlated with existential distress (r = 0.819, p < 0.01), and self-disclosure was negatively correlated with existential distress (r = -0.817, p < 0.01). Self-disclosure played a partial mediating role between intolerance of uncertainty and existential distress, accounting for 43.2% of the total effect. CONCLUSION: Intolerance of uncertainty can directly affect existential distress and indirectly influence it through the mediating role of self-disclosure. Medical staff should not only take measures to reduce patients' intolerance of uncertainty but also promote their active self-disclosure to further lower the level of existential distress.