{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:27:51Z","timestamp":1786980471005,"version":"build-2736575974"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effective self-management behaviors can improve outcomes in kidney transplant recipients. Although existing evidence has shown that alexithymia is negatively associated with self-management behaviors, the underlying mechanisms remain unclear. This study aimed to explore the relationships among the alexithymia, emotion regulation, psychological resilience and self-management behaviors in kidney transplant recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study recruited kidney transplant recipients who attended follow-up visits at three major tertiary hospitals in northern and southern China between January and March 2026.\u00a0A general demographic questionnaire, the Perth Alexithymia Questionnaire, the Emotion Regulation Questionnaire, the Kidney Transplant Psychological Resilience Scale, and the Kidney Transplant Self-Management Scale were used for data collection. The relationships among alexithymia, emotion regulation, psychological resilience, and self-management were examined using correlation analysis, linear regression, and structural equation modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 299 kidney transplant recipients were included in the analysis. The structural equation model demonstrated a good fit to the data (CFI\u00a0=\u00a00.949 - 0.955; RMSEA\u00a0=\u00a00.077 - 0.085). Alexithymia was directly associated with self-management in two parallel structural equation models (direct effect = \u22120.129 in the cognitive reappraisal model; \u22120.119 in the expressive suppression model). Emotion regulation strategies, including cognitive reappraisal and expressive suppression, mediated the association between alexithymia and self-management (indirect effect = \u22120.030 and \u22120.041, respectively). Furthermore, a chain mediating pathway through emotion regulation strategies and psychological resilience was identified (indirect effect = \u22120.028 and \u22120.067, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alexithymia is both directly and indirectly associated with poorer self-management behaviors in kidney transplant recipients, with emotion regulation strategies and psychological resilience serving as significant mediators. These findings provide preliminary directions for optimizing personalized self-management support following kidney transplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1909478","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:00:31Z","timestamp":1786978831000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between alexithymia, emotion regulation, psychological resilience, and self-management behaviors in kidney transplant recipients: a multicenter structural equation modeling study"],"prefix":"10.3389","volume":"17","author":[{"given":"Meiqian","family":"Chen","sequence":"first","affiliation":[{"name":"Organ Transplantation Center, Fujian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Zou","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center, Fujian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianyu","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Laoshan Nursing Unit of Kidney and Lung Transplantation, Affiliated Hospital of Qingdao University","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiying","family":"Lei","sequence":"additional","affiliation":[{"name":"Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyi","family":"Huang","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center, Fujian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Fu","sequence":"additional","affiliation":[{"name":"Heart Medical Center, Fujian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanjuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nursing, Fujian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.18502\/ijph.v50i8.6801","article-title":"Graft and patient survival rates in kidney transplantation, and their associated factors: a systematic review and metaanalysis","volume":"50","author":"Ghelichi-Ghojogh","year":"2021","journal-title":"Iranian J Public Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"24","DOI":"10.3390\/ijms262412041","article-title":"The impact of stress on the functioning and survival of transplanted kidneys-biological mechanisms, clinical implications, and therapeutic perspectives","volume":"26","author":"Piechowiak","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S436833","article-title":"Is non-adherence associated with adverse outcomes in kidney transplant recipients? 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