The Chain Mediating Effect of Sleep Quality and Family Resilience Between Depressive Mood and Treatment Compliance in Continuous Blood Purification Patients

Abstract

Background: Patients undergoing continuous blood purification (CBP) face considerable physical and psychological burdens, and the prevalence of depressive mood is high, which adversely affects treatment compliance. This study aimed to investigate the chain mediating roles of sleep quality and family resilience in the relationship between depressive mood and treatment compliance among patients with CBP.

Methods: A cross-sectional study was conducted in 195 patients with CBP from May 2024 to May 2025. Assessment included the Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Family Resilience Assessment Scale-Chinese version (FRAS-C), and Dialysis Treatment Adherence Scale (DTAS). We performed Pearson correlation, multiple linear regression, and bootstrap mediation analyses (PROCESS Macro Model 6) to test the hypothesized chain mediation model.

Results: The mean scores were SDS 52.64 ± 5.82, PSQI 10.55 ± 4.08, FRAS-C 87.09 ± 11.24, and DTAS 70.95 ± 13.25. Depressive mood was significantly associated of poorer sleep quality (β = 0.521, p < 0.01) with lower family resilience (β = −0.391, p < 0.01), which in turn were associated with lower treatment adherence (β = −0.253 and β = 0.192, respectively, both p < 0.01). The total indirect effect accounted for 41.74% of the total effect, with the chain path (depression → sleep → resilience → adherence) contributing 5.06%. After adjusting for age, the model remained significant. 

Conclusions: Improving sleep quality and enhancing family resilience may be potential strategies to mitigate the adverse effects of depressive mood on self-reported treatment compliance in patients with CBP, though these findings require confirmation using adherence measures validated specifically for the CBP population.