Illness perception and psychosocial adjustment in young and middle-aged liver transplant recipients during the early postoperative period: the serial mediating roles of perceived social support and quality of life

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Abstract
Objective: Psychosocial adjustment is an important component of recovery after liver transplantation, particularly among young and middle-aged recipients during the early postoperative period. Although illness perception has been associated with psychosocial adjustment, the statistical pathways underlying this association in this population remain unclear. This study aimed to examine the association between illness perception and psychosocial adjustment and to determine whether perceived social support and quality of life statistically mediated this association. Methods: A questionnaire survey was conducted among 216 young and middle-aged liver transplant recipients. The instruments included the Brief Illness Perception Questionnaire (B-IPQ), Perceived Social Support Scale (PSSS), Post-Liver Transplant Quality of Life Questionnaire, and Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR). Structural equation modeling was used to evaluate the proposed statistical serial mediation model, and the Bootstrap method was adopted to examine the significance of statistical indirect effects. Results: Illness perception was positively associated with psychosocial adjustment problems ( β = 0.240, p = 0.002). Bootstrap analysis showed significant statistical indirect associations through perceived social support, quality of life, and the sequential pathway of perceived social support and quality of life. The total indirect association accounted for 43.26% of the total association. Conclusion: Illness perception was associated with poorer psychosocial adjustment among young and middle-aged liver transplant recipients during the early postoperative period, with perceived social support and quality of life serving as statistical mediators. These findings suggest that early postoperative interventions may need to integrate illness-cognition regulation, supportive resource enhancement, and quality-of-life improvement to support psychosocial adjustment.

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