Psychosocial pathways linking family support to sleep disorders in maintenance hemodialysis: the chain mediating role of depression and fatigue

Sleep disorders are prevalent in maintenance hemodialysis (MHD) patients and contribute to reduced quality of life, cardiovascular risk, and mortality. While psychosocial factors influence sleep quality, the pathways linking family support to sleep outcomes in this population remain unclear. This cross-sectional study aimed to examine whether depression and fatigue mediate the association between family support and sleep disorders among MHD patients using a chain mediation model. A total of 308 patients from two tertiary hospitals in Xinjiang, China (December 2024-March 2025) completed the Perceived Social Support from Family Scale, Self-Rating Depression Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, and Pittsburgh Sleep Quality Index. Spearman correlation and structural equation modeling with 5,000 bootstrap resamples were used to analyze direct and indirect effects. Results indicated that higher family support correlated with lower depression (<i>r</i> = -0.67), lower sleep disorder severity (<i>r</i> = -0.51), and lower fatigue (<i>r</i> = 0.58; higher score = less fatigue; all <i>p</i> < 0.01). Mediation analysis showed family support directly predicted fewer sleep disorders (<i>β</i> = -0.315, <i>p</i> = 0.006) and indirectly <i>via</i> depression (<i>β</i> = -0.418, <i>p</i> < 0.001) and <i>via</i> the depression→fatigue pathway (<i>β</i> = -0.104, <i>p</i> = 0.048). Fatigue alone was not a significant mediator. Indirect pathways accounted for 64.2% of the total effect. These findings suggest family support influences sleep quality in MHD primarily through reducing depression and, secondarily, through a depression-fatigue pathway. Targeted psychosocial interventions that enhance family involvement and address depressive symptoms may mitigate sleep disorders in this high-risk population.