The mediating effect of health-related hardiness on the degree of physical disability and perceived stress in Chinese female patients with neuromyelitis optica spectrum disorder

Abstract

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a rare and chronic disease of the central nervous system. The characteristics and main symptoms of recurrent NMOSD lead to an increase in psychological stress and accelerate a decline in the patients’ quality of life. The incidence of NMOSD in the Chinese population is much higher than that for other countries and the majority of NMOSD patients are female. In general, there are sex differences in the perception and management of stress, with females experiencing higher levels of perceived stress than males. Thus, we should be concerned about the psychological issues experienced by Chinese female NMOSD patients. Health-related hardness is a psychological adjustment factor that could affect perceptions of illness that impact on NMOSD patients. The objective of this study was to evaluate the mediating role of health-related hardiness on physical disability and perceived stress in Chinese NMOSD female patients. MethodsParticipants were 68 females patients with NMOSD treated at the Department of Neurology, Huashan Hospital, Fudan University, China, between March and September 2018. Patients were evaluated for their degree of physical disability, perceived stress, and health-related hardiness. Measures included the Expanded Disability Status Scale (EDSS), Perceived Stress Scale (PSS), and Health-related Hardiness Scale (HRHS). Pearson's correlation analyses and stepwise multiple linear regression analysis were used. ResultsFindings indicated a positive correlation between the PSS and EDSS (r = 0.735, P < 0.001) and a negative correlation between the PSS and HRHS total score (r = −0.441, P < 0.001). After adjusting for the confounding factors, the EDSS was found to have a positive predictive effect on the PSS (β = 2.743, P = 0.000), and the HRHS was found to have a negative predictive effect on the PSS (β = −0.152, P = 0.04). Mediation analysis showed a direct effect of the EDSS on the PSS, and as a mediating variable for health-related hardiness (α = −1.928, b = −0.152, c = 2.743, c’ = 2.481), which was statistically significant (P < 0.05). The mediating effect of health-related hardiness accounted for 10.68% of the total effect. ConclusionsAs a mediating variable, health-related hardiness indirectly affected perceived stress caused by physical disability and improved health-related hardiness. This was beneficial in reducing psychological stress and promoting mental health in NMOSD female patients.