The mediating role of health anxiety, resilience, and body image in the relationship between pain and sleep in hematopoietic stem cell transplantation patients

Abstract

Introduction Bio-psychological factors may affect the relationship between pain and sleep, but they are understudied in hematopoietic stem cell transplantation (HSCT) patients. This study investigated the mediating role of health anxiety, resilience, and body image in the relationship between pain and sleep in HSCT patients. Methods In this cross-sectional study, 210 HSCT patients from Motahari clinic, Shiraz University of Medical Sciences were recruited using convenience sampling. Demographic and clinical characteristics, Pittsburgh Sleep Quality Index, Numeric Rating Scale of Pain, Health Anxiety Inventory, Body Image Scale, and Connor-Davidson’s Resilience were used. Data were analyzed using SPSS Macro process and structural equation model. Results Approximately half of the participants reported good sleep quality. Mean resilience and health anxiety scores were 66.02 (SD = 14.85), 23.88 (SD = 10.30), respectively, indicating moderate levels. The mean of body image (5.90; SD = 4.26) indicated low negative body image. Sleep was correlated with pain (r = 0.31, p < 0.001), resilience (r=˗0.39, p < 0.001), health anxiety (r = 0.45, p < 0.001), and body image (r = 0.42, p < 0.001). Poorer sleep was associated with higher pain, health anxiety, body image concerns, and lower resilience. Resilience (β = 0.16, CI = 0.03 to 0.31), health anxiety (β = 0.17, CI = 0.04 to 0.32), and body image (β = 0.25, CI = 0.10 to 0.43) mediated the pain-sleep relationship, explaining 31% of the total effect. Conclusion Poorer sleep quality was associated with higher pain, health anxiety, lower resilience, and negative body image. These factors mediated the pain-sleep relationship in HSCT patients, highlighting the need for nursing interventions targeting resilience, body image, and health anxiety to improve pain and sleep outcomes.