Assessing Fear of Progression, Stigma, and Psychological Detachment in Hemodialysis Patients: A Structural Equation Modeling Study

Abstract Aims: To explore the mediating effects of fear of disease progression (FoP) and stigma on the relationship between the level of family caregiving and psychological disengagement in maintenance hemodialysis (MHD) patients. Methods: A cross-sectional study was conducted including 320 MHD patients from a hemodialysis center in China. Data were collected using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Social Impact Scale (SIS), Family APGAR Index, and Psychological Disengagement Scale. Structural equation modeling was performed via AMOS 26.0. Results: The total score for psychological disengagement was 193.10±24.37, indicating a moderate level. Family caring degree had a positive correlation with FoP (r=0.157, P<0.05) and negative correlations with stigma (r=-0.205, P<0.01) and psychological disengagement (r=-0.218, P<0.01). The fear of disease progression partially mediated the relationship between stigma and psychological disengagement (mediation effect=0.112, 16.20% of total effect). Conclusion: Psychological disengagement among MHD patients is influenced by stigma, FoP, and family support. Interventions targeting family-centered care and stigma reduction may enhance psychological disengagement.