ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1665458
Heterogeneity of Benefit Finding in Maintenance Hemodialysis Patients: A Decision Tree-Based Subgroup Analysis of Self-Efficacy and Social Support
Provisionally accepted
- 1Naval Medical University School of Nursing, Shanghai, China
- 2Chongqing Mental Health Centre, Chongqing, China
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Background: Benefit finding (BF) improves quality of life in maintenance hemodialysis (MHD) patients, yet population heterogeneity remains understudied. This study explores how self-efficacy and social support jointly influence BF patterns and identifies distinct patient subgroups. Methods: This multi-center cross-sectional study was conducted from April to September 2023 at five tertiary hospitals in Shanghai, China, enrolling 352 MHD patients. Data from the Benefit Finding Scale, General Self-Efficacy Scale, and Perceived Social Support Scale were used to construct a Classification and Regression Tree (CART) model employing five-fold cross-validation, with a maximum depth of 3 and a minimum leaf node size of 10%. Results: The CART model (R²=0.278) identified five distinct BF subgroups (p<0.001): Low Self-Efficacy Constrained Group, Psychological Resource Deficient Group, Internally Belief Driven Group, Balanced Resource Adaptation Group, and Resource Integrated Advantage Group, each characterized by unique combinations of self-efficacy and social support. Significant differences were observed among the subgroups in terms of gender(p=0.045), education level(p=0.010), and employment status(p=0.003) Conclusion: BF levels in MHD patients demonstrated significant variations influenced by the combined effects of self-efficacy and social support. The decision tree model successfully identified patient subgroups with distinct psychological resource configurations. These findings provide a theoretical foundation for implementing stratified and personalized psychological interventions in clinical practice. Clinicians can identify and prioritize vulnerable patients who simultaneously lack self-efficacy and social support, offering them targeted positive psychological interventions that may potentially improve treatment adherence and long-term prognosis.
Keywords: Renal Dialysis, self-efficacy, social support, Benefit finding, decision tree
Received: 14 Jul 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Fan, Tong, Wang, Gong, Wu and Chu. 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:
Jing Wu, Naval Medical University School of Nursing, Shanghai, China
Jing Chu, Naval Medical University School of Nursing, Shanghai, China
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