Role of positive psychological resources in associations between social support and sleep quality among kidney transplant recipients

Abstract To examine the potential mediating role of positive psychological resources in the association between social support and sleep quality among kidney transplant recipients, and to provide preliminary evidence to inform the development of targeted interventions aimed at improving sleep quality. A convenience sample of 343 stable kidney transplant recipients, including both inpatients and outpatients, was recruited from a tertiary hospital in Shenyang, Liaoning Province, China, between December 2024 and June 2025. Data were collected using a general information questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Social Support Rating Scale (SSRS), the Connor–Davidson Resilience Scale (CD-RISC), and the General Self-Efficacy Scale (GSES). Statistical analyses and path modeling were performed using SPSS 29.0 and AMOS 24.0. Mediation effects were tested using path analysis based on observed variables. The prevalence of poor sleep quality among kidney transplant recipients was 34.7%. Correlation analyses indicated that PSQI scores were negatively associated with social support, self-efficacy, and resilience (P < 0.01). Social support was positively correlated with self-efficacy and resilience (P < 0.01), and self-efficacy was positively correlated with resilience (P < 0.01). These correlation results were consistent with the hypothesized mediation pathways. Path analyses suggested that self-efficacy and resilience partially mediated the association between social support and sleep quality. The indirect effect via self-efficacy accounted for 51.5% of the total effect, whereas the indirect effect via resilience accounted for 52.4%. These percentages reflect the contribution of each mediating pathway in the respective models, rather than independent portions of the overall effect. Positive psychological resources, particularly self-efficacy and resilience, were associated with sleep quality among kidney transplant recipients and may be involved in the relationship between social support and sleep quality. These findings suggest that positive psychological resources may be relevant considerations in interventions aimed at improving sleep in this population.