Impact of narrative support on stigma, anxiety, and depression in young and middle-aged patients undergoing maintenance hemodialysis

doi:10.5498/wjp.119511

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Sep 19, 2026; 16(9): 119511
Published online Sep 19, 2026. doi: 10.5498/wjp.119511

Table 1 Clinical characteristics of patients undergoing maintenance hemodialysis, n (%)/mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P value
Age	45.20 ± 6.54	43.41 ± 7.26	0.105
Sex			0.492
Male	49 (57.65)	46 (63.01)
Female	36 (42.35)	27 (36.99)
BMI (kg/m²)	21.40 ± 3.37	21.15 ± 2.94	0.636
Dialysis vintage			0.563
1-3 years	47 (55.29)	36 (49.32)
> 3 years	38 (44.71)	37 (50.68)
Employment status			0.941
Employed	43 (50.59)	35 (47.95)
Unemployed	27 (31.76)	24 (32.88)
Retired	15 (17.65)	14 (19.18)
Marital status			0.500
Married	70 (82.35)	57 (78.08)
Single	15 (17.65)	16 (21.92)
Education level			0.643
Junior high school and below	33 (38.82)	29 (39.73)
High school or junior college	42 (49.41)	32 (43.84)
College and above	10 (11.76)	12 (16.44)
Per capita monthly household income (RMB)			0.436
≤ 3000	46 (54.12)	44 (60.27)
> 3000	39 (45.88)	29 (39.73)
Form of payment			1.000¹
Self-financed	2 (2.35)	2 (2.74)
Medical insurance	83 (97.65)	71 (97.26)
Primary disease			0.911
Diabetes	30 (35.29)	24 (32.88)
Hypertension	18 (21.18)	18 (24.66)
Chronic glomerulonephritis	25 (29.41)	18 (24.66)
Polycystic kidney disease	7 (8.24)	7 (9.59)
Others	5 (5.88)	6 (8.22)
Hb (g/L)	113.73 ± 12.59	111.16 ± 12.13	0.193
Serum albumin (g/L)	40.05 ± 4.42	39.06 ± 3.11	0.111
Serum calcium (mmol/L)	2.40 ± 0.48	2.51 ± 0.38	0.117
Serum phosphorus (mmol/L)	1.90 ± 0.42	1.86 ± 0.38	0.535
Kt/V	1.23 ± 0.33	1.20 ± 0.26	0.551
Urea reduction ratio (%)	65.04 ± 15.61	62.14 ± 17.35	0.270

¹Fisher’s exact test.

BMI: Body mass index; Hb: Hemoglobin; Kt/V: Urea clearance index.

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Table 2 Comparison of stigma, mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P¹
Total SIS score
Pre-intervention	70.04 ± 7.57	70.98 ± 8.29	0.458
Post-intervention	51.06 ± 9.08	63.62 ± 8.31	< 0.001
P²	< 0.001	< 0.001	-
Social exclusion
Pre-intervention	25.64 ± 4.82	25.56 ± 5.98	0.926
Post-intervention	18.09 ± 4.26	23.33 ± 4.91	< 0.001
P²	< 0.001	0.015	-
Financial insecurity
Pre-intervention	9.62 ± 2.71	9.58 ± 2.83	0.928
Post-intervention	7.41 ± 2.85	9.37 ± 2.64	< 0.001
P²	< 0.001	0.644	-
Internalized shame
Pre-intervention	16.03 ± 2.24	16.65 ± 2.18	0.081
Post-intervention	11.24 ± 3.62	14.73 ± 2.32	< 0.001
P²	< 0.001	< 0.001	-
Social isolation
Pre-intervention	18.75 ± 4.66	19.10 ± 4.49	0.633
Post-intervention	14.32 ± 5.02	16.19 ± 3.45	0.008
P²	< 0.001	< 0.001	-

¹Comparison between the observation and control groups.

²Within-group comparison of the pre- and post-intervention values.

SIS: Social Impact Scale.

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Table 3 Comparison of negative emotions, mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P¹
SAS
Pre-intervention	51.12 ± 8.05	50.87 ± 8.21	0.847
Post-intervention	40.76 ± 7.19	48.58 ± 9.11	< 0.001
P²	< 0.001	0.113	-
SDS
Pre-intervention	47.25 ± 7.14	46.97 ± 7.42	0.810
Post-intervention	38.98 ± 6.36	43.18 ± 8.71	< 0.001
P²	< 0.001	0.005	-

¹Comparison between the observation and control groups.

²Within-group comparison of pre- and post-intervention values.

SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale.

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Table 4 Comparison of treatment adherence rates, mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P¹
Total treatment adherence
Pre-intervention	626.38 ± 54.51	622.02 ± 49.91	0.603
Post-intervention	835.07 ± 64.06	656.41 ± 67.28	< 0.001
P²	< 0.001	< 0.001	-
Treatment adherence
Pre-intervention	275.11 ± 35.62	270.02 ± 37.11	0.381
Post-intervention	355.34 ± 33.74	284.47 ± 41.15	< 0.001
P²	< 0.001	0.027	-
Medication adherence
Pre-intervention	95.24 ± 24.57	96.84 ± 19.12	0.653
Post-intervention	140.15 ± 36.18	103.01 ± 34.11	< 0.001
P²	< 0.001	0.180	-
Fluid restrictions
Pre-intervention	123.02 ± 16.87	121.91 ± 13.54	0.653
Post-intervention	170.75 ± 18.20	129.33 ± 21.26	< 0.001
P²	< 0.001	0.013	-
Diet recommendations
Pre-intervention	133.01 ± 28.54	133.25 ± 23.77	0.959
Post-intervention	168.82 ± 24.44	139.60 ± 31.19	< 0.001
P²	< 0.001	0.169

¹Comparison between the observation and control groups.

²Within-group comparison of pre- and post-intervention values.

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Table 5 Comparison of sleep quality, mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P¹
Total PSQI score
Pre-intervention	8.71 ± 1.08	8.73 ± 1.09	0.908
Post-intervention	6.60 ± 1.94	8.11 ± 2.14	< 0.001
P²	< 0.001	0.029	-
Subjective sleep quality
Pre-intervention	1.13 ± 0.36	1.21 ± 0.42	0.199
Post-intervention	0.91 ± 0.37	0.95 ± 0.40	0.515
P²	< 0.001	< 0.001	-
Sleep latency
Pre-intervention	1.30 ± 0.43	1.28 ± 0.39	0.761
Post-intervention	1.01 ± 0.42	1.23 ± 0.46	0.002
P²	< 0.001	0.480	-
Sleep duration
Pre-intervention	0.98 ± 0.45	1.04 ± 0.44	0.417
Post-intervention	0.82 ± 0.41	1.19 ± 0.43	< 0.001
P²	0.016	0.039	-
Habitual sleep efficiency
Pre-intervention	1.41 ± 0.44	1.39 ± 0.46	0.781
Post-intervention	0.94 ± 0.39	1.30 ± 0.49	< 0.001
P²	< 0.001	0.255	-
Sleep disturbances
Pre-intervention	1.41 ± 0.37	1.38 ± 0.45	0.646
Post-intervention	1.04 ± 0.42	1.27 ± 0.48	0.002
P²	< 0.001	0.155	-
Use of sleep medications
Pre-intervention	1.06 ± 0.30	1.02 ± 0.26	0.376
Post-intervention	0.85 ± 0.39	0.90 ± 0.34	0.396
P²	< 0.001	0.018	-
Daytime dysfunction
Pre-intervention	1.42 ± 0.47	1.41 ± 0.39	0.886
Post-intervention	1.04 ± 0.42	1.26 ± 0.53	0.004
P²	< 0.001	0.053	-

¹Comparison between the observation and control groups.

²Within-group comparison of the pre- and post-intervention values.

PSQI: Pittsburgh Sleep Quality Index.

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Table 6 Comparison of quality of life, mean ± SD

Characteristics	Observation group (n = 85)	Control group (n = 73)	P¹
PF
Pre-intervention	57.42 ± 13.01	58.87 ± 12.45	0.477
Post-intervention	73.64 ± 15.57	62.60 ± 16.73	< 0.001
P²	< 0.001	0.129	-
RP
Pre-intervention	54.62 ± 11.33	53.87 ± 9.94	0.661
Post-intervention	63.76 ± 14.91	56.26 ± 11.87	< 0.001
P²	< 0.001	0.189	-
BP
Pre-intervention	62.53 ± 14.92	61.87 ± 8.05	0.736
Post-intervention	74.49 ± 15.47	66.12 ± 12.45	< 0.001
P²	< 0.001	0.016	-
GH
Pre-intervention	36.28 ± 14.12	35.91 ± 11.02	0.856
Post-intervention	63.25 ± 12.36	40.67 ± 15.47	< 0.001
P²	< 0.001	0.022	-
VT
Pre-intervention	41.16 ± 9.81	40.88 ± 8.29	0.848
Post-intervention	53.85 ± 9.16	41.34 ± 10.65	< 0.001
P²	< 0.001	0.771	-
RE
Pre-intervention	42.13 ± 15.04	40.97 ± 11.21	0.589
Post-intervention	63.41 ± 11.60	45.22 ± 12.33	< 0.001
P²	< 0.001	0.031	-
MH
Pre-intervention	57.02 ± 10.11	56.87 ± 8.84	0.922
Post-intervention	65.36 ± 12.28	60.16 ± 9.90	0.004
P²	< 0.001	0.036	-
SF
Pre-intervention	64.82 ± 10.98	65.67 ± 8.65	0.594
Post-intervention	85.38 ± 11.55	73.74 ± 10.46	< 0.001
P²	< 0.001	< 0.001	-

¹Comparison between the observation and control groups.

²Within-group comparison of the pre- and post-intervention values.

PF: Physical functioning; RP: Role-physical; BP: Bodily pain; GH: General health; VT: Vitality; RE: Role-emotional; MH: Mental health; SF: Social functioning.

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Table 7 Comparison of changes in indicators (pre- vs post-treatment)

Characteristics	Difference score according to baseline		P value
Characteristics	Observation group (n = 85)	Control group (n = 73)	P value
Total SIS score	-18.00 (-26.00, -11.00)	-8.00 (-15.00, 0.00)	< 0.001
Social exclusion	-8.00 (-12.00, -3.00)	-2.00 (-8.00, 2.00)	< 0.001
Financial insecurity	-2.00 (-5.00, 1.00)	0.00 (-3.00, 3.00)	0.002
Internalized shame	-5.00 (-8.00, -2.00)	-1.00 (-3.00, 0.00)	< 0.001
Social isolation	-6.00 (-10.00, -1.00)	-3.00 (-6.00, 0.00)	0.017
SAS	-10.00 (-19.00, -3.00)	-3.00 (-9.00, 4.00)	< 0.001
SDS	-9.00 (-15.00, -1.00)	-4.00 (-12.00, 6.00)	0.029
Total treatment adherence	231.00 (153.00, 268.00)	39.00 (-9.00, 79.00)	< 0.001
Treatment adherence	83.00 (49.00, 117.00)	13.00 (-21.00, 61.00)	< 0.001
Medication adherence	48.00 (14.00, 75.00)	7.00 (-22.00, 29.00)	< 0.001
Fluid restrictions	49.00 (29.00, 72.00)	6.00 (-8.00, 21.00)	< 0.001
Diet recommendations	34.00 (12.00, 63.00)	7.00 (-19.00, 32.00)	< 0.001
Total PSQI score	-2.00 (-3.00, -1.00)	-1.00 (-2.00, 1.00)	0.002
Subjective sleep quality	0.00 (0.00, 0.00)	0.00 (-1.00, 0.00)	0.627
Sleep latency	-0.30 (-0.70, 0.10)	-0.10 (-0.40, 0.20)	0.015
Sleep duration	0.00 (0.00, 0.00)	0.00 (0.00, 0.00)	0.002
Habitual sleep efficiency	-0.50 (-0.80, -0.10)	-0.10 (-0.60, 0.30)	< 0.001
Sleep disturbances	-0.30 (-0.70, -0.10)	-0.20 (-0.70, 0.40)	0.019
Use of sleep medications	0.00 (0.00, 0.00)	0.00 (0.00, 0.00)	0.183
Daytime dysfunction	-0.30 (-0.70, 0.00)	-0.30 (-0.60, 0.20)	0.101
PF	17.00 (5.00, 31.00)	6.00 (-9.00, 18.00)	< 0.001
RP	10.00 (-3.00, 22.00)	1.00 (-10.00, 13.00)	0.007
BP	13.00 (0.00, 28.00)	8.00 (-5.00, 14.00)	0.014
GH	27.00 (16.00, 38.00)	4.00 (-8.00, 18.00)	< 0.001
VT	13.00 (4.00, 21.00)	-1.00 (-10.00, 9.00)	< 0.001
RE	19.00 (10.00, 32.00)	3.00 (-7.00, 15.00)	< 0.001
MH	7.00 (0.00, 19.00)	5.00 (-5.00, 11.00)	0.049
SF	23.00 (10.00, 31.00)	7.00 (0.00, 18.00)	< 0.001

SIS: Social Impact Scale; SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale; PSQI: Pittsburgh Sleep Quality Index; PF: Physical functioning; RP: Role-physical; BP: Bodily pain; GH: General health; VT: Vitality; RE: Role-emotional; MH: Mental health; SF: Social functioning.

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Citation: Xu WL, Wang Y, Zhu L, Zhang X, Tan YS, Peng PP, Yang XJ. Impact of narrative support on stigma, anxiety, and depression in young and middle-aged patients undergoing maintenance hemodialysis. World J Psychiatry 2026; 16(9): 119511
URL: https://www.wjgnet.com/2220-3206/full/v16/i9/119511.htm
DOI: https://dx.doi.org/10.5498/wjp.119511

Xu WL, Wang Y, Zhu L, Zhang X, Tan YS, Peng PP, Yang XJ. Impact of narrative support on stigma, anxiety, and depression in young and middle-aged patients undergoing maintenance hemodialysis. World J Psychiatry 2026; 16(9): 119511 [DOI: 10.5498/wjp.119511]

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