Family support influences sleep quality in MHD patients primarily through reducing depression and, secondarily, through a depression-fatigue pathway, with indirect pathways accounting for 64.2% of the total effect.
Higher family support was significantly correlated with lower depression, lower sleep disorder severity, and lower fatigue in MHD patients.
Family support directly predicted fewer sleep disorders in MHD patients.
Depression significantly mediated the relationship between family support and sleep disorders.
Depression and fatigue together formed a significant chain mediating pathway from family support to sleep disorders.
Fatigue alone was not a significant mediator between family support and sleep disorders.
Indirect psychosocial pathways accounted for the majority of the total effect of family support on sleep disorders.
The study sample consisted of 308 maintenance hemodialysis patients from two tertiary hospitals in Xinjiang, China.
This research suggests that among patients receiving maintenance hemodialysis (a treatment for kidney failure), having stronger family support is associated with better sleep quality, and this relationship works largely through psychological and physical well-being pathways. Specifically, the study found that family support appears to reduce depression, and lower depression is associated with less fatigue, both of which are in turn linked to fewer sleep problems. Fatigue on its own did not appear to be a meaningful link between family support and sleep, but it did play a role when depression came first. Together, these indirect pathways through depression and fatigue explained about 64% of the total association between family support and sleep outcomes. This research suggests that simply having family involved in care is not enough on its own to improve sleep in hemodialysis patients — the mental health benefits of that support, particularly reduced depression, appear to be a critical mechanism. The findings highlight that sleep problems in this population are deeply tied to psychosocial factors, not just the physical demands of dialysis. Addressing depression and fatigue in hemodialysis patients, alongside encouraging family participation in care, may be important components of efforts to improve sleep quality. Because this was a cross-sectional study (meaning data were collected at one point in time), it is not possible to determine cause and effect from these findings alone. The study was also conducted in a specific region of China, which may limit how broadly the findings apply to other populations. Nevertheless, this research suggests that psychosocial interventions targeting family involvement and depressive symptoms could be valuable for improving sleep and overall quality of life in people undergoing long-term hemodialysis.
Tan H, Li L, Zhang Y, Ma X, Zhang H. (2026). Psychosocial pathways linking family support to sleep disorders in maintenance hemodialysis: the chain mediating role of depression and fatigue.. Renal failure. https://doi.org/10.1080/0886022X.2025.2598958