Psychological resilience and monthly household income are the core influencing factors for distress tolerance in patients undergoing maintenance hemodialysis: a cross-sectional study of latent profile analysis

Maintenance hemodialysis (MHD) patients are prone to negative emotional experiences due to long-term treatment burden and physical and mental stress. Distress tolerance is an important psychological ability for patients to cope with negative emotions, but the heterogeneity of distress tolerance in this population has not been systematically described. This study aimed to explore the latent class characteristics of distress tolerance and influencing factors of distress tolerance in MHD patients, so as to provide a reference for the development of clinical intervention programs.

A cross-sectional study was conducted on 323 MHD patients enrolled using convenience sampling from Department of Nephrology of Hefei First People’s Hospital between September 2025 and March 2026. General information questionnaire, Chinese Revised Version of Distress Tolerance Scale (DTS-CR), Perceived Stress Scale-10 (PSS-10), 10-item Connor Davidson Resilience Scale (CD-RISC-10), and Satisfaction with Life Scale (SWLS) were used to measure the sociodemographic characteristics and disease-related indicators, distress tolerance, perceived stress, resilience, and life satisfaction of the patients, respectively. Latent profile analysis was used to identify distinct profiles of distress tolerance. Univariate and multivariate logistic regression analyses were applied to identify their influencing factors of different classes.

The MHD patients had a distress tolerance score of 39.96±7.76; they were classified into 3 profiles: high tolerance-acceptance adaptation type (n=61, 18.9%), moderate tolerance-regulation difficulty type (n=180, 55.7%), and low tolerance-distress sensitivity type (n=82, 25.4%). There were statistically significant differences among the 3 groups of patients in age, marital status, monthly per capita household income, medical insurance type, number of complications, self-care ability, self-rated health status, personality type, perceived stress score, psychological resilience score, and life satisfaction score (P<0.05). Multinomial logistic regression analysis showed that monthly per capita household income (<3000 yuan, OR=5.817, 95%CI: 1.005 to 33.665), self-care ability (completely independent, OR=0.039, 95%CI: 0.003 to 0.522), personality type (introverted, OR=6.758, 95%CI: 1.410 to 32.386), perceived stress score (OR=1.442, 95%CI: 1.206 to 1.724), psychological resilience score (OR= 0.766, 95%CI: 0.636 to 0.923), and life satisfaction score (OR=0.783, 95%CI: 0.650 to 0.943) were associated with the low tolerance-distress sensitivity type (P<0.05). Monthly per capita household income (<3000 yuan, OR=10.412, 95%CI: 3.158 to 34.325; 3000 to 5000 yuan, OR=5.546, 95%CI: 2.341 to 13.139), psychological resilience score (OR=0.883, 95%CI: 0.782 to 0.997), and perceived stress score (OR=1.117, 95%CI: 1.006 to 1.241) were associated with the moderate tolerance-regulation difficulty type (P<0.05).

Distress tolerance in MHD patients can be classified into 3 latent classes: high tolerance-acceptance adaptation type, moderate tolerance-regulation difficulty type, and low tolerance-distress sensitivity type. Monthly per capita household income, self-care ability, personality type, perceived stress, psychological resilience, and life satisfaction are closely associated with distress tolerance in MHD patients. Clinically, stratified intervention measures should be implemented according to the different classes of distress tolerance. For patients with the low tolerance-distress sensitivity type, individualized cognitive behavioral intervention and meticulous management of complications should be carried out to improve their emotional control ability. For patients with the moderate tolerance-regulation difficulty type, emotional skills training and goal setting should be focused on to restore self-management confidence. For patients with the high tolerance-acceptance adaptation type, their advantageous resources should be fully explored to exert their educational and peer-influence role.