The effects of psychological resilience and economic toxicity on quality of life in maintenance hemodialysis patients: a mixed study

Background: Quality of life of maintenance hemodialysis patients is affected by multidimensional factors.Based on the stress coping theory and economic toxicity theory, we analyzed the current situation and factors affecting the quality of life of this group. We integrate the synergistic effects of social support, economic hardship and individual characteristics on the quality of life, and propose strategies oriented to "economic-psychological" dual-path interventions and optimization of medical insurance policies. Methods: This study utilized a mixed research methodology. Based on a cross-sectional survey design, questionnaires were administered to 452 patients; psychological resilience, intensity of economic toxicity and quality of life levels were quantified, and the pathways and effect strengths among the three were clarified. One-on-one semi-structured interviews were conducted with 32 patients to analyze the pathways of psychological stress and the mechanisms of social support that affect the quality of life, and to reveal the subjective experience and contextualization factors that cannot be captured by quantitative data. Results: Overall economic toxicity was mild to severe, psychological resiliencewas at a low level, and quality of life was moderate. Economic toxicity, psychological resilience, marital status, work status, education level, and the presence of children were the key factors affecting the quality of life. The qualitative interviews distilled four themes: "multidimensional challenges of economic burden", "economic coping strategies", "interaction between psychological resilience and health management", and "medical and social system deficits". Social system deficits". Conclusions: Economic toxicity, psychological resilience and quality of life were positively correlated. Economic toxicity directly restricts patients' access to healthcare services through the multidimensional stress chain formed by the cycleof economic resource depletion, family tension, social exclusion, and economic vulnerability, and also has a significant negative impact on interpersonal relationships and psychological health. Psychological resilience mitigates the economicimpact through the dual pathways of "resource enhancement" and "cognitive restructuring", but its moderating effect is limited by the lack of external support, such as uneven access to low income policies and the lack of primary healthcare resources. Based on this, it is necessary to build a three-tiered coordinatedintervention system of "policy relief - psychological empowerment - social mutual assistance" to realize a systematic breakthrough in economic pressure reliefand psychosocial adaptation.