Correlation between life satisfaction, pleasure level, and negative emotion in patients with chronic renal failure

Abstract

BACKGROUND

Anxiety, depression, and other negative emotions are common among patients with chronic renal failure (CRF). Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.

AIM

To explore the correlations among life satisfaction, pleasure levels, and negative emotions in patients with CRF.

METHODS

One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included. The Depression, Anxiety, and Stress Scale (DASS-21), Satisfaction with Life Scale (SWLS), and Temporal Experience of Pleasure Scale (TEPS) were used to evaluate negative emotions, life satisfaction, and pleasure level, respectively. Pearson’s correlation coefficient analyzed the correlation between life satisfaction, pleasure level, and negative emotions. Linear regression analysis identified the factors affecting negative emotions.

RESULTS

The average DASS-21 score among patients with CRF was 51.90 ± 2.30, with subscale scores of 17.90 ± 1.50 for depression, 18.53 ± 1.18 for anxiety, and 15.47 ± 2.36 for stress, all significantly higher than the domestic norm (P < 0.05). The average SWLS score was 22.17 ± 4.90. Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores (P < 0.05), but not with the individual depression, anxiety, or stress dimensions. The average TEPS score was 67.80 ± 8.34. TEPS scores were negatively correlated with the DASS-21 score and the stress dimension (P < 0.05), but not with depression or anxiety. Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores (P < 0.05).

CONCLUSION

Patients with CRF experience high levels of negative emotions, which are negatively correlated with life satisfaction and pleasure. Furthermore, pleasure level had an impact on negative emotions.

Key Words: Chronic renal failure; Hemodialysis; Negative emotion; Life satisfaction; Pleasure; Correlation

Core Tip: Evidence on how life satisfaction and pleasure levels influence negative emotions in patients with chronic renal failure is limited. In this study of 100 patients with chronic renal failure, life satisfaction and pleasure levels were negatively correlated with negative emotions. Notably, pleasure level affected negative emotions. The findings highlight the need for emotional care during treatment.

INTRODUCTION

Chronic renal failure (CRF) is a clinical syndrome characterized by acid-base imbalance and systemic organ involvement due to persistent chronic renal dysfunction, resulting in significant renal atrophy and an inability to maintain basic functions[1]. Patients with CRF are prone to different degrees of mental health problems due to the long-term burden of illness, lack of social function, and adverse treatment effects. Negative emotions such as anxiety and depression are particularly common[2]. Traditionally, psychological interventions for patients with CRF were mostly aimed at eliminating negative emotions. However, the role of positive psychological dimensions has been neglected. Life satisfaction refers to an individual’s overall subjective evaluation of their living conditions, while pleasure reflects the experience of happiness derived from daily activities. Both are cognitive components of psychological well-being and the main indicators in quality-of-life evaluation. Currently, it is believed that anxiety, depression, and other negative emotions negatively affect the quality of life of patients with CRF[3,4]. However, there are few reports on the effects of life satisfaction and pleasure levels on negative emotions. Therefore, this study aimed to examine the correlations among life satisfaction, pleasure level, and negative emotions in patients with CRF to provide a reference for psychological intervention.

MATERIALS AND METHODS

Patient characteristics

A total of 100 patients with CRF who received therapy at The First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included in the study. The inclusion criteria were as follows: (1) Clinical diagnosis of CRF; (2) Age ≥ 18 years; (3) Received standard maintenance hemodialysis for 4 hours 3 times a week using bicarbonate dialysate; (4) Hemodialysis treatment for ≥ 6 months; (5) Ability to communicate verbally; and (6) Willingness to participate in the study. The exclusion criteria were as follows: (1) An estimated survival time of < 6 months; (2) Serious accidents in the past three months; (3) Severe physical diseases; (4) Mental illness; (5) Cognitive impairment; and (6) Poor compliance or inability to cooperate with the survey. This study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital of Jinzhou Medical University.

Sample size calculation

According to the Kendall method[5], the sample size should be 5-10 times the number of variables, with a total of 12 variables in this study, and considering 20% inefficiency, the sample size range is 72-144 cases, that is, at least 72 cases are required for this study.

Survey tools

(1) Demographic characteristics questionnaire: A self-designed questionnaire was used to collect general demographic data, including age, sex, marital status, education level, course of disease, and source of medical expenses; (2) Depression, Anxiety, and Stress Scale (DASS-21)[6]. The DASS-21 includes three dimensions: Depression, anxiety, and stress. Each dimension contains seven questions (21 items total). Responses are scored on a 4-point Likert scale (0-3), ranging from “did not apply to me” to “applied to me always”. The total score ranges from 0 to 63, with higher scores indicating severe depression, anxiety, and stress. The Chinese version of the DASS-21 has a Cronbach’s alpha of 0.91; (3) Satisfaction with Life Scale (SWLS)[7]: The SWLS includes five questions rated on a 7-point Likert scale, where responses range from “strongly disagree” to “strongly agree”. The total score ranges from 5 to 35, with higher scores indicating greater life satisfaction. The Chinese version of the SWSL has a Cronbach’s alpha of 0.78; and (4) Temporal Experience of Pleasure Scale (TEPS)[8]: The TEPS assesses pleasure through 20 items describing various pleasurable situations. Items are rated on a 6-point Likert scale (1-6), from “not like me at all” to “very true of me”. The total score ranges from 20 to 120, with higher scores indicating a greater capacity to experience pleasure. The Chinese version of the TEPS has a Cronbach’s alpha of 0.83.

Data collection and quality control

The study was conducted by researchers who received uniform training. A questionnaire survey was administered at the hospital. Before the survey, the researchers used standardized and unified instructions to introduce the purpose, significance, questionnaire completion requirements, and data confidentiality measures to the respondents. To ensure accuracy and authenticity, all questionnaires were completed anonymously. Upon collection, the investigators examined the recovered questionnaires. Incomplete or invalid responses (e.g., careless answers or substantial missing data) were excluded. Valid questionnaires were numbered and entered for analyses.

Statistical analysis

Data analysis was performed using SPSS version 26.0. General demographic data were described using frequency distributions. Quantitative data with non-normal distributions were presented as mean ± SD, and an independent sample t-test was adopted for comparison. Pearson correlation coefficients were used for correlation analyses, while linear regression analysis was used to identify the factors influencing negative emotions. Statistical significance was set at P < 0.05.

RESULTS

Negative emotions

The average DASS-21 score among patients with CRF was 51.90 ± 2.30. Scores for the three dimensions (depression, anxiety, and stress) were significantly higher than those of the domestic norm (P < 0.05; Table 1). Among the three dimensions, the mean scores ranked from highest to lowest as follows: Anxiety, depression, and stress (Figure 1).

Figure 1  Depression, Anxiety, and Stress Scale scores across the depression, anxiety, and stress dimensions in patients with chronic renal failure.

Table 1 Depression, Anxiety, and Stress Scale scores and their distribution in patients with chronic renal failure.

Dimensionality	Scoring range	Scores	Domestic norm
Depression	15-21	17.90 ± 1.50a	6.31 ± 6.82
Anxiety	15-21	18.53 ± 1.18a	6.31 ± 6.82
Stress	10-21	15.47 ± 2.36a	9.72 ± 7.41
Total scores	46-59	51.90 ± 2.30

^aP < 0.05 vs the domestic norm.

Differences in negative emotions across demographic characteristics

Differences in total DASS-21 scores were analyzed across various demographic and clinical variables. There were no statistically significant differences in average DASS-21 scores based on age, sex, disease course, duration of dialysis, hypertension or diabetes, marital status, education level, place of residence, monthly income per capita, or medical expenses (P > 0.05; Table 2).

Table 2 Comparative analysis of Depression, Anxiety, and Stress Scale scores across different demographic characteristics in patients with chronic renal failure.

Variable	Case	Mean	SD	t/F	P value
Age				1.118	0.266
< 48 years	49	52.24	2.98
≥ 48 years	51	51.57	3.01
Disease course				0.415	0.679
< 4.3 years	47	51.77	2.94
≥ 4.3 years	53	52.02	3.07
Hemodialysis age				0.199	0.843
< 4.0 years	49	51.84	2.92
≥ 4.0 years	51	51.96	3.10
Gender				1.218	0.226
Male	59	52.20	2.98
Female	41	51.46	3.00
Hypertension				0.779	0.438
No	63	52.08	2.78
Yes	37	51.59	3.34
Diabetes				1.334	0.185
No	84	51.73	2.96
Yes	16	52.81	3.12
Marital status				0.036	0.964
Married	84	51.92	2.97
Divorced	12	51.92	3.06
Loss of spouse	4	51.50	4.20
Educational level				1.584	0.210
Junior high school and below	49	52.18	3.13
High school or technical secondary school	35	51.20	2.82
College and above	16	52.56	2.83
Place of abode				0.594	0.554
City	22	52.50	2.82
Town	32	51.63	2.84
Village	46	51.80	3.20
Family per capita monthly income				0.371	0.774
≤ 1000 yuan	28	52.39	3.39
1000-3000 yuan	34	51.73	3.01
3000-5000 yuan	30	51.68	2.97
≥ 5000 yuan	8	51.50	1.77
Source of medical expenses				0.898	0.371
Medical insurance	94	51.97	3.02
Private expense	6	50.83	2.64

Correlation analysis

The SWLS scores ranged from 7 to 32, with an average of 22.17 ± 4.90. TEPS scores ranged from 45 to 90, with an average of 67.80 ± 8.34. Pearson correlation analysis revealed a negative correlation between SWSL and DASS-21 scores (r = -0.226, P = 0.024; Figure 2A). Similarly, TEPS scores were negatively correlated with DASS-21 scores (r = -0.335, P = 0.001; Figure 2B). When analyzing the individual dimensions of the DASS-21, SWLS scores were not significantly correlated with any of the three dimensions (P > 0.05). However, TEPS scores were negatively correlated with the stress dimension (r = -0.284, P = 0.004; Table 3).

Figure 2 Analysis of the correlation. A: Analysis of the correlation between Depression, Anxiety, and Stress Scale and Satisfaction with Life Scale scores in patients with chronic renal failure; B: Analysis of the correlation between Depression, Anxiety, and Stress Scale and Temporal Experience of Pleasure Scale scores in patients with chronic renal failure. DASS-21: Depression, Anxiety, and Stress Scale; SWLS: Satisfaction with Life Scale; TEPS: Temporal Experience of Pleasure Scale.

Table 3 Domain-specific correlations of Satisfaction with Life Scale and Temporal Experience of Pleasure Scale scores with Depression, Anxiety, and Stress Scale dimensions in patients with chronic renal failure.

	Depression		Anxiety		Stress
	r	P value	r	P value	r	P value
SWLS	-0.156	0.120	0.014	0.894	-0.195	0.052
TEPS	-0.121	0.231	-0.131	0.194	-0.284	0.004

SWLS: Satisfaction with Life Scale; TEPS: Temporal Experience of Pleasure Scale.

Linear regression analysis

To identify influencing factors, DASS-21 scores were used as the dependent variable, while SWLS and TEPS scores were included as independent variables in a linear regression equation. The results showed that TEPS scores had a statistically significant effect on DASS-21 scores (P < 0.05; Table 4).

Table 4 Factors influencing Depression, Anxiety, and Stress Scale scores in patients with chronic renal failure: A linear regression analysis.

Variable	B	SE	β	t	P value
Constant	59.425	1.958		30.352	< 0.001
SWLS	-0.082	0.047	-0.168	-1.751	0.083
TEPS	-0.096	0.030	-0.303	-3.160	0.002

SWLS: Satisfaction with Life Scale; TEPS: Temporal Experience of Pleasure Scale.

DISCUSSION

According to statistics from the International Association of Kidney Diseases, the global annual incidence of CRF is approximately 98-198 cases/million population[9]. In China, the incidence is estimated at 1.7%, with about 100 patients with CRF per million population[10]. As the disease progresses irreversibly toward end-stage renal failure, kidney transplantation remains the only curative treatment. However, due to the scarcity of donor kidneys, maintenance hemodialysis is the primary clinical intervention. Based on the principle of a semi-permeable membrane, hemodialysis removes harmful metabolic wastes and excess electrolytes; purifies the blood; corrects fluid, electrolyte, and acid-base imbalances; partially replaces renal function; and prolongs survival time[11].

Despite its benefits, long-term maintenance hemodialysis is often accompanied by endocrine dysfunction that may lead to complications such as hypertension, arrhythmia, and heart failure[12]. These complications not only threaten physical health but also cause psychological distress. Many patients perceive themselves as burdens on their families and experience reduced self-worth owing to their dependence and limited autonomy, often resulting in persistent negative emotional states. In this study, the DASS-21 was used to evaluate the emotional state of patients with CRF. Among the three subscales, anxiety had the highest average score, and all subscales were higher than the domestic norms, indicating that patients with CRF experience elevated negative emotions, with anxiety being the most prominent.

Gadia et al[13] found that among 100 patients with chronic kidney disease undergoing continuous blood purification, the prevalence rates of anxiety and depression were 66% and 61%, respectively, and were significantly correlated with sex, occupation, and dialysis duration. Similarly, Mosleh et al[14] found that among 122 patients with chronic kidney disease who received hemodialysis, 24.6% had depressive symptoms and 19.7% had anxiety symptoms, both significantly correlated with age and sex, but not with disease course, dialysis duration, or education level. Our study analyzed the demographic characteristics and found no significant differences in DASS-21 scores based on age, sex, or disease course. This discrepancy may be related to differences in inclusion and exclusion criteria as well as the different scales used. Additionally, this study showed that SWLS scores were negatively correlated with DASS-21 scores, indicating that lower life satisfaction is associated with higher levels of negative emotions in patients with CRF.

Patients experiencing negative emotions often have impaired psychological adjustment abilities, which can directly exacerbate physical symptoms. After physical and social function decline, patients commonly experience reduced capacity for daily activities and social participation, leading to a diminished quality of life. This decline may, in turn, negatively impact their life satisfaction[15]. A study has shown that life satisfaction in patients with chronic kidney disease is positively correlated with positive coping styles[16]. We believe that reduced life satisfaction and poor treatment compliance negatively affect treatment outcomes and may further aggravate negative emotions. Our results also showed a negative correlation between TEPS scores and DASS-21 scores in patients with CRF. Linear regression analysis confirmed that TEPS scores had a statistically significant effect on DASS-21 scores, suggesting that the level of pleasure experienced influences negative emotional states in these patients. This may be because, due to energy depletion and physical fatigue, patients often abandon former hobbies and social activities. Additionally, psychological distress can cause loss of interest in previously enjoyed activities and social withdrawal, resulting in social alienation. Social alienation is a negative coping style that can contribute to the development of negative emotions[17,18].

Currently, healthcare providers often focus on physical disease management, ignoring patients’ psychological well-being. The psychological burden is usually assessed subjectively by patients themselves or their families[19]. Therefore, based on the findings of this study, it is recommended to implement a personalized pleasure activation program in which healthcare professionals assess and encourage patients to regain or develop personal interests (such as listening to music, gardening), and ensure that it is feasible during treatment through adaptive adjustments. In addition, structured group psychological interventions, such as mindfulness training or art therapy groups should be implemented to help patients find pleasure in the present experience, and enhance social support and counter social alienation in group interactions. Family collaborative participation must be promoted, family members should be encouraged to consciously recreate shared happy moments (such as preparing meals together, reviewing family photos) through health education, and transform family support into real-time enjoyable experiences. In addition, the role of positive communication of medical staff should be adequately defined, affirming the patient’s efforts and value in daily interactions, encouraging them to share positive experiences, and enhancing their sense of self-worth from medical relationships.

This study has certain limitations. First, this is a cross-sectional study that reveals correlations between variables, but cannot infer causality, which needs to be clarified through longitudinal studies or intervention trials in the future. Secondly, although no significant impact of demographic variables on negative emotional total scores has been found, there may be undetected interactions or subgroup effects, and more complex statistical models (such as moderation or mediating effect models) need to be introduced in the future to further explore the mechanism of social support, coping styles and other factors in the relationship between life satisfaction, pleasure and negative emotions. In addition, this study is a single-center study with a limited sample size, which may affect the generalizability of the results, and therefore, the outcomes of this study should be interpreted with caution.

CONCLUSION

In summary, patients with CRF exhibited high levels of negative emotions, which were negatively correlated with life satisfaction and pleasure levels. Notably, pleasure level significantly influenced negative emotions.