Chain mediating effect of resilience and disease acceptance on social support and self-management behavior in patients with liver cirrhosis

To explore the chain mediating effects of psychological resilience and disease acceptance on the relationship between social support and self-management behavior in patients with cirrhosis. This retrospective cross-sectional study included 187 patients with cirrhosis hospitalized from January 2024 to January 2026. Relevant data were collected using general information questionnaires and standardized scales. SPSS 26.0 with the PROCESS plug-in was used for statistical analysis and chain mediation modeling to explore the mediating effects of psychological resilience and disease acceptance on the association between social support and self-management among cirrhotic patients. Baseline scale scores of 187 cirrhotic patients: BRS-6 (15.74 ± 2.44), AIS (20.32 ± 2.65), social support (27.53 ± 4.59), self-management (43.60 ± 4.51). All indicators showed significant positive pairwise correlations (P < 0.05). Social support showed a prominent total statistical association with self-management (adjusted β = 0.542, t = 8.701, P < 0.001) and retained a significant direct correlational link after accounting for mediators and covariates (β = 0.425, t = 5.792, P < 0.001). The chained pathway of social support-resilience-disease acceptance-self-management was statistically significant (β = 0.047, Boot 95%CI: 0.020-0.074). Total standardized indirect effect was 0.434 (Boot 95%CI: 0.294-0.579), occupying 50.60% of the total effect.Summary statistics for the regression model predicting self-management were reported: R = 0.711, R²=0.506, F = 24.742, P < 0.001, indicating the model explained 50.6% of the total variance in self-management behavior. Social support was associated with self-management behavior among patients with liver cirrhosis, both directly and indirectly, through psychological resilience and disease acceptance, acting independently and in sequence. Interventions that strengthen social support, psychological resilience, and disease acceptance may improve self-management, although their effects on long-term clinical outcomes remain to be established.