The relationship between illness perception and vision-related quality of life among Chinese patients with diabetic retinopathy: the mediating role of resignation coping style

Background: Maladaptive illness perception and coping strategies have been linked to illness-related quality of life in patients with chronic diseases. However, the impact of illness perception and coping strategies on vision-related quality of life (VRQOL) in patients with diabetic retinopathy (DR), a significant microvascular complication of diabetes mellitus, remains unclear. This study aims to evaluate the associations among illness perception, coping styles, and VRQOL in Chinese patients with DR, and to explore the mediating role of coping styles in the relationship between illness perception and VRQOL.

Methods: This cross-sectional study included 303 adult Chinese with DR recruited from a general Grade-A tertiary hospital in Hunan, China. All participants completed clinical and demographic questionnaires. The Brief Illness Perception Questionnaire (BIPQ), the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25), and the Medical Coping Modes Questionnaire were respectively adopted to assess the illness perception, VRQOL and coping styles. The BIPQ total scores were converted to logit scores using Rasch analysis. The NEI-VFQ-25 composite scores were converted to estimated person measures based on Rasch analysis and the method of successive dichotomizations. The relationships among these variables were assessed through independent-sample t-test, one-way analysis of variance, correlation analyses and multiple linear regression analysis, while SPSS Process model and the bootstrap analysis were utilized to evaluate the mediating effect.

Results: Illness perception was positively correlated with resignation coping style (r = 0.33, P < 0.001) and negatively correlated with VRQOL (r = -0.43, P < 0.001). Resignation coping style was negatively correlated with VRQOL (r = -0.38, P < 0.001). Illness perception significantly predicted resignation coping style (t = 5.91, P < 0.001) and resignation coping style significantly predicted VRQOL (t = -5.30, P < 0.001). The mediating effect through resignation coping was - 0.49 (95% CI: -0.75 to -0.27), accounting for 21.08% of the total effect of illness perception on VRQOL.

Conclusion: The study revealed that the resignation coping style partially mediated the relationship between illness perception and VRQOL among DR patients. Specifically, DR patients may accept their worsening circumstances without attempting to change them due to their perception that their illness is threatening and beyond control. This resignation coping strategy could, in turn, lead to poorer VRQOL. These findings suggest that interventions targeting the improvement of illness perception and coping strategies could enhance the VRQOL of DR patients.