{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:43:42Z","timestamp":1792165422615,"version":"4.4.0"},"reference-count":50,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Patients undergoing hemodialysis face numerous challenges and adversities, which can impact their mental health. Several previous studies have indicated that certain Stoic tenets may be beneficial in alleviating suffering and enhancing mental health outcomes in situations such as chronic disease. Therefore, this study explored the effectiveness of Stoic training in reducing psychological distress and enhancing self\u2010efficacy among hemodialysis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomized controlled trial was conducted from February to May 2025. The 8\u2010week intervention began with virtual Stoic training sessions and transitioned to weekly in\u2010person meetings. Data were collected using a demographic questionnaire, the Kessler Psychological Distress Questionnaire (K\u201010), and the Self\u2010Efficacy for Managing Chronic Diseases 6\u2010Item Scale. Data were analyzed using SPSS version 22. Independent\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests,\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests, and multiple linear regression were used for analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 50 participants (25 in each group) were analyzed. The multiple linear regression model, controlling for baseline scores, hypertension, and education level, showed that the intervention was significantly associated with a reduction in psychological distress (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20094.75,\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.02, 95% CI [8.88, 0.61]) and an increase in self\u2010efficacy for managing chronic disease (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20098.76,\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.009, 95% CI [2.51, 15.01]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that while Stoic training can help alleviate psychological distress, further research is needed to develop an expanded training protocol. This may involve longer practice durations and more scenario\u2010based exercises to significantly enhance self\u2010efficacy. Researchers should consider these factors in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73336","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:44:42Z","timestamp":1791186282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effectiveness of a Stoicism\u2010Based Educational Package on Psychological Distress and Self\u2010Efficacy in Patients Under Hemodialysis: A Randomized Controlled Trial"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9885-7325","authenticated-orcid":false,"given":"Amirhossein","family":"Boostani","sequence":"first","affiliation":[{"name":"Instructor of Nursing, Department of Nursing, Ferdows Faculty of Medical Sciences, Chamran Hospital of Ferdows Birjand University of Medical Sciences Birjand Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0982-4973","authenticated-orcid":false,"given":"Amirmohamad","family":"Momeni","sequence":"additional","affiliation":[{"name":"Student Research Committee Birjand University of Medical Sciences Birjand Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4868-6315","authenticated-orcid":false,"given":"Mohammad\u2010Ali","family":"Cheraghi","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Nursing Management, Spiritual Health Group Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Salmani","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Faculty of Health, Geriatric Health Research Center Birjand University of Medical Sciences Birjand Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4091-7185","authenticated-orcid":false,"given":"Mozhgan","family":"Moshtagh","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center Birjand University of Medical Sciences Birjand Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/0886022X.2024.2331613"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/jehp.jehp_461_18"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-9987.12914"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/jehp.jehp_148_18"},{"issue":"3","key":"e_1_2_14_6_1","first-page":"1\u201311","article-title":"The Relationships Between Spirituality, Coping Strategies, and Psychological Distress Among Haemodialysis Patients","volume":"34","author":"Shukri N. 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