ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1637110
Social support and quality of life in Chinese heart transplant recipients: mediation through uncertainty in illness and moderation by psychological resilience
Provisionally accepted
- 1Shenzhen University, Shenzhen, China
- 2City University of Macau, Taipa, Macao, SAR China
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Introduction: In China's collectivist healthcare context, the mechanisms linking social support to quality of life (QoL) in heart transplant recipients remain unclear. This study integrates Mishel's uncertainty in illness theory and Confucian resilience frameworks to cross-sectionally examine dual pathways: direct enhancement of QoL through social support and indirect reduction of uncertainty in illness, moderated by culturally embedded psychological resilience. Methods: A nationwide cross-sectional study included 428 Chinese heart transplant recipients. Social support (SSRS), uncertainty in illness (MUIS-A), resilience (CD-RISC), and QoL (SF-36) were assessed. Mediation (PROCESS Model 4) and moderated mediation (Model 14) were tested using 5,000 bootstrap resamples, controlling for age, gender, and transplant duration. Results: Social support directly improved QoL (B = 0.625, p < 0.001, direct effect = 0.435, 95% CI [0.285, 0.584]) and indirectly reduced uncertainty in illness (indirect effect = 0.19, 95% CI [0.126, 0.265]). Psychological resilience moderated the uncertainty in illness-QoL link (B = 0.007, p < 0.001), with stronger negative effects in low-resilience individuals (B = -0.372 vs. high-resilience B = -0.111). Conclusion: Based on this cross-sectional study, social support demonstrates significant associations with dual pathways: directly associated with improved QoL through relational support networks and indirectly linked to reduced uncertainty in illness via culturally mediated cognitive reframing. Culturally interventions integrating family-centered care and resilience training are recommended to improve long-term outcomes.
Keywords: Heart Transplantation, social support, uncertainty in illness, psychological resilience, Quality of Life, moderated mediation model
Received: 28 May 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Gao, Gui, Zhu, Bian, Shen and Jiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Heyong Shen, City University of Macau, Taipa, Macao, SAR China
Can Jiao, Shenzhen University, Shenzhen, China
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