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Table 2 Illustrative quotations for the four themes assessing mental health

From: Mental health and its influencing factors of maintenance hemodialysis patients: a semi-structured interview study

Themes

Minor themes

Minimal themes

Quotes

Acceptance of disease

High acceptance group

Acceptance at the early stage of hemodialysis

“[…] My father had polycystic kidney disease, and he died of this disease. This is a genetic disease that I had long known I was at risk for. I was ready for it when I eventually learned that I also had this disease. The kidney transplant was not an option, so I knew that hemodialysis was the only way to stay alive […]” (MHD18, male, 67 years old, polycystic kidney disease)

   

“[…] I had already died once, so I could accept anything. I underwent four surgeries under general anesthesia, included an amputation. Once, I was in a coma in the ICU for several days, and others thought I would not wake up, but I finally made it and was transferred to the normal ward. It took me a long time to recover and get out of the hospital, but I knew since then that I could accept anything. If you want to live, you have to do hemodialysis; if you don’t want to live, you don’t need to do hemodialysis. Why not? Hemodialysis is meant to keep you alive[…]” (MHD22, male, 54 years old, diabetic nephropathy)

   

“[…] People should learn to be grateful. Although I’m sick and have suffered some pain, it is already a very good thing that I can have regular hemodialysis. I’m not afraid of death. All of this is arranged by God. God will always bless us! […]” (MHD20, female, 59 years old, kidney tumor)

  

Gradually accepted disease and hemodialysis

“[…] When I first learned that hemodialysis was needed, I thought it was a big treatment and it caused me a certain degree of psychological stress. However, after routine hemodialysis, my physical condition has gradually normalized, which has greatly reduced my psychological stress. Now I can gradually accept my condition […]” (MHD2, male, 54 years old, diabetic nephropathy)

   

“[…] In the past, my eyes could not see, my body was uncomfortable, and I could not take care of myself. When I first began hemodialysis, I felt depressed. Everyone advised me that I would be fine after hemodialysis. And, my body did become much better after hemodialysis, and I was able to see after the eye surgery. Now I can see things clearly and take care of myself in life. I can gradually accept the hemodialysis […]” (MHD9, male, 59 years old, diabetic nephropathy)

 

Low acceptance group

Cannot accept disease and hemodialysis

“[…] Why me? I haven’t done anything wrong, and now I’m on hemodialysis. I can’t accept it, but there’s no other choice to stay alive […]” (MHD11, female, 74 years old, diabetic nephropathy)

   

“[…] I used to be a math teacher. After the students had graduated, I found out that I was sick through a physical examination. At the time, I couldn’t accept it, that I would die soon. When I first started hemodialysis, I was very scared. Although I’m no longer afraid, I still can’t accept this reality. I’m very depressed since I can’t do anything now […]” (MHD32, male, 64 years old, diabetic nephropathy)

  

Forced to accept disease and hemodialysis

“[…] I had been ill for many years. At first, I took medicine regularly, but gradually my kidney stopped working. I had to start hemodialysis. I did not know what hemodialysis was. I didn’t feel too depressed, just lived day by day, yielded to my fate […]” (MHD12, male, 87 years old, chronic glomerulonephritis)

   

“[…] The disease cannot be cured, I can only maintain my life. I can’t understand why this is, but there is no other way, you and the disease have to coexist […]” (MHD16, male, 81 years old, hypertensive nephropathy)

Complications

Acute complications

 

“[…] Before the hemodialysis, I sometimes felt nauseated, nauseous, and itchy. Now, after a few months of regular hemodialysis, I feel less nauseous and the itchiness has stopped. In the middle and later stages of hemodialysis, though, I usually have a headache. And I’m very tired after the hemodialysis […]” (MHD32, male, 64 years old, diabetic nephropathy)

   

“[…] After the hemodialysis, I felt very tired and very weak. When I got home, I would hurry to bed after eating. I wouldn’t recover until the next day, but I only ever took one day off. On the third day, I would have hemodialysis again. I was really irritable. Three times a week for hemodialysis is really a waste of time, which also seriously affects my quality of life […]” (MHD19, female, 65 years old, ANCA-associated vasculitis)

 

Chronic complications

 

“[…] I didn’t feel anything else, but I was itchy, so itchy. I scratched all over my body. The itching seriously affected my quality of life. Last winter, I had pneumonia, and since then my legs have felt weak and I’ve found it very hard to walk […]” (MHD29, male, 79 years old, diabetic nephropathy)

   

“[…] My body is definitely becoming weaker and weaker. It’s not like it used to be. I used to have a lot of ideas of things to do, but now I don’t have any ideas because of my body. My legs have become more and more weak, and my eyes cannot see anything, I dare not go out, in case I fall down accidentally […]” (MHD23, female, 54 years old, diabetic nephropathy)

   

“[…] Sometimes my body is very uncomfortable, and all kinds of small problems appear. Sometimes I feel that I take too much medicine, and I don’t want to take it anymore. Vascular access complications severely affect my life […]” (MHD12, male, 87 years old, chronic glomerulonephritis)

Stress and coping styles

Self-perceived stress group

 

“[…] When I’m stressed and unhappy, I can go a day without talking or watching TV at home. I’m not interested in doing anything, including playing with my phone. In fact, as long as I don’t think about anything, it relieves the stress. If I don’t pay any attention to it, these emotions will pass after a while[…]” (MHD23, female, 52 years old, diabetic nephropathy).

   

“[…] I have to undergo hemodialysis three times a week, and this is stressful and it makes me really irritable. My husband usually tells me, ‘You should accept your fate and leave the rest of your life to me. I will take good care of you, let’s eat whatever you want.’ It helps me let go of a lot of the stress. He sometimes takes me out for a drive to relax, I’m very happy for this […]” (MHD19, female, 65 years old, ANCA-associated vasculitis)

 

Self-perceived stress-free group

 

“[…] I don’t experience any stress, and don’t need to worry about anything, Because I already understand my disease in its entirety. I feel good. The only thing I need to do is to take care of myself […]” (MHD18, male, 67 years old, polycystic kidney disease)

   

“[…] I don’t feel any stress now, and I feel quite confident. I’m just going to live like this. I will do whatever the doctor says. I plan to live for another 20 years, and by then I will be in my 80s […]” (MHD25, male, 62 years old, chronic glomerulonephritis)

Social support

Family

Spouse

“[…] The person who takes care of me is my lover. She is very hardworking and helps me a lot. She takes care not only of me, but also my parents and my nephew. I am really grateful for her […]” (MHD2, male, 54 years old, diabetic nephropathy)

   

“[…] Usually my husband does the housework. He usually asks me what I want to eat. If it isn’t easy for him to cook, he will go out and buy it. He usually buys my favorite food for me, which makes me very cared for. Sometimes my arms or legs hurt, and he will immediately give me massages. My daughter can’t take care of me because she has to work and she also has children to raise. She calls and says hello to me most of the time, but in my daily life, I depend primarily on my husband […]” (MHD19, female, 65 years old, ANCA-associated vasculitis)

  

Children

“[…] My daughter-in-law takes charge of cooking for me, and my son usually drives me to the hospital. They all care about me. Every time I go to see a doctor, my son drives and his wife helps me by pushing the wheelchair and contacting the hospital […]” (MHD12, male, 87 years old, chronic glomerulonephritis)

  

Parents

“[…] Usually, my parents take care of me, and urge me to take my medicine. I can drive to the hemodialysis appointments by myself […]” (MHD17, male, 33 years old, diabetic nephropathy)

  

Relatives

“[…] My sister usually calls and chats with me, updates me, and gives me emotional support. My cousin drives me to the hospital every time […]” (MHD13, male, 56 years old, diabetic nephropathy)

 

Friends

 

“[…} My family members are in other cities, and I am the only one working in Beijing. Right now I am in a good condition and can take care of myself. When I feel lonely, though, I usually invite several friends over to have dinner and chat. They make me happy […]” (MHD21, male, 33 years old, chronic glomerulonephritis)

 

Medical staff

 

“[…] Now, the closest people to me are the doctors and nurses who arrange the hemodialysis for me, explain the tests to me, adjust my medicine, and usually chat with me. It’s all good now […]” (MHD16, male, 81 years old, hypertensive nephropathy)