The relevance of perceived stress in the quality of life of pulmonary arterial hypertension patients

Abstract

Background: Pulmonary arterial hypertension (PAH) is an incurable rare disease causing high levels of physical disability and impairment in quality of life (QoL). We examined the impact of disease status, psychological flexibility, and social support on the QoL of PAH patients, following the needs-based model of QoL. Special attention was given to the mediating role of perceived stress. Methods: Cross-sectional design. Seventy-two patients completed measures of disease status, psychological flexibility, social support, perceived stress, and QoL. A path analysis was conducted to examine the relationship among these variables. Findings: The obtained model showed a good fit to the data: χ2(2)=1.36, p=0.51, RMSEA=0.00, CFI=1.00, and TLI=1.02. Disease status (β=0.70) and perceived stress (β=0.28) were significant predictors of QoL. Disease status (β=0.28), psychological flexibility (β=0.46), and social support (β=-0.22) were significant predictors of perceived stress. Perceived stress partially mediated the impact of disease status on QoL (β=0.08) and fully mediated the impact of psychological flexibility (β=0.13) on QoL. The indirect effect of social support on QoL via perceived stress approached statistical significance (β=-0.06, p=0.08). Discussion: The effects of psychological flexibility and social support on QoL were fully accounted by a reduction in the level of patients' perceived stress, i.e. the extent to which they found their lives uncontrollable, unpredictable, and overloaded. This suggest that, controlling for disease status, patients with higher levels of psychological flexibility and/or social support may have shown a greater capacity to behave in ways that ensured need-satisfaction, i.e. higher QoL.