Abstract:

Objective: To explore the impact of patient’s rumination of disease on their psychological health-related quality of life in patients with chronic obstructive pulmonary disease (COPD), and to examine the mediating role of self-efficacy between these two variables. Methods: A convenience sampling method was used to select 263 COPD patients admitted to Shanghai Second People’s Hospital between June 2023 and October 2025 as study subjects, according to inclusion criteria. A general information questionnaire, the General Self-Efficacy Scale, the Rumination Scale, and the SF-12 Quality of Life Scale were used to conduct a questionnaire survey on all subjects, and the corresponding scores were calculated. Spearman correlation analysis was performed on self-efficacy, rumination on disease, and mental health-related quality of life using SPSS 21.0 software. A structural equation model was constructed using Amos 28.0 software to test the mediating effect of self-efficacy. Results: The average scores for self-efficacy, patient’s rumination on disease, and mental health-related quality of life in COPD patients were (23.42±5.51), (54.65±6.84), and (62.71±8.78), respectively. Spearman correlation analysis showed that self-efficacy was significantly negatively correlated with patient’s rumination on disease (r=-0.798, P<0.001) and significantly positively correlated with mental health-related quality of life (r=0.859, P<0.001); patient’s rumination on disease was significantly negatively correlated with mental health-related quality of life (r=-0.864, P<0.001). The structural equation model fitted well (χ²/dF=2.143, IFI=0.983, TLI=0.976, CFI=0.983, RMSEA=0.066). Mediation analysis showed that self-efficacy partially mediated the relationship between patient’s rumination on disease and quality of life related to mental health (indirect effect (95%CI)=-0.471 (-0.574 to -0.382), P<0.001; direct effect (95%CI)=-0.484 (-0.608 to -0.373), P<0.001; total effect (95%CI)=-0.955 (-1.069 to -0.854), P<0.001), with the mediating effect accounting for 49.32% of the total effect. Conclusion: Patient’s rumination on COPD can indirectly affect their mental health-related quality of life by reducing self-efficacy. Clinical interventions should emphasize on improving patients’ self-efficacy to mitigate the adverse effects of patient’s rumination of COPD on their mental health-related quality of life.

Key words: Self care, Pulmonary disease, chronic obstructive, Self psychology, Value of life, Nursing evaluation research