Effects of social support and type D personality, with serial mediation by psychological resilience and positive coping styles – a cross-sectional study: Subjective well-being in hemodialysis patients

This study aimed to examine the effects of social support and type D personality on subjective well-being (SWB) in hemodialysis patients and to verify the serial mediating roles of psychological resilience and positive coping styles, addressing the lack of research on multifactor serial mediation mechanisms. A cross-sectional survey was conducted among 427 hemodialysis patients in Shanxi, China. Pearson correlation, multiple linear regression, and bootstrap resampling (5000 resamples) were used for analysis, with annual household income and dialysis vintage as control variables. After controlling for covariates, social support positively predicted SWB (total effect = 0.361, P  < .001), whereas type D personality negatively predicted SWB (total effect = −0.235, P  < .001). Psychological resilience and positive coping styles exerted significant serial mediating effects in both pathways, with total indirect effects accounting for 55.12% and 59.15% of the total effects, respectively. All effects were statistically significant. Social support is a protective factor and type D personality a risk factor for SWB in hemodialysis patients. Both act through the serial mediating pathway of psychological resilience and positive coping styles, providing clear targets for clinical psychological interventions.