Internal self-disclosure and external social support play chain mediating roles in regulating alexithymia from stigma in female patients with pelvic floor dysfunction: a cross-sectional study

Jiang Lu; Wang Ru; Luo Zhengwei; Wu Ting; Liu Nian; Guo Xiaoli

doi:10.16016/j.2097-0927.202607038

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Internal self-disclosure and external social support play chain mediating roles in regulating alexithymia from stigma in female patients with pelvic floor dysfunction: a cross-sectional study

Evidence-Based Nursing Horizons | 更新时间：2026-10-19

- Internal self-disclosure and external social support play chain mediating roles in regulating alexithymia from stigma in female patients with pelvic floor dysfunction: a cross-sectional study
- Journal of Army Medical University Vol. 48, Issue 19, Pages: 2809-2818(2026)
- 作者机构：
  
  1.新疆医科大学护理学院，新疆乌鲁木齐；新疆医科大学第一附属医院：2.泌尿外科
  2.妇科，新疆乌鲁木齐
  3.Department of Gynecology， the First Affiliated Hospital of Xinjiang Medical University， Urumqi， Xinjiang， China
- 作者简介：
  
  Guo Xiaoli，E-mail： 18099186671@163.com
- 基金信息：
  
  the Special Scientific Research Project for Young Medical Talents in the Xinjiang Uygur Autonomous Region(WJWY-202409)
- DOI：10.16016/j.2097-0927.202607038
  CLC： R195.4;R395.1;R711.5
- Received：09 July 2026，
  
  Revised：2026-08-02，
  
  Accepted：27 August 2026，
  
  Published：15 October 2026
- 稿件说明：
移动端阅览
蒋露，汪茹，罗正伟，等.内在自我表露与外在社会支持可链式中介调节女性盆底功能障碍患者由病耻感而来的述情障碍：一项横断面研究［J］.陆军军医大学学报，2026，48（19）：2809-2818.DOI：10.16016/j.2097-0927.202607038.

Jiang L，Wang R，Luo Z W，et al.Internal self-disclosure and external social support play chain mediating roles in regulating alexithymia from stigma in female patients with pelvic floor dysfunction： a cross-sectional study［J］.J Army Med Univ，2026，48（19）：2809-2818.DOI：10.16016/j.2097-0927.202607038.
蒋露，汪茹，罗正伟，等.内在自我表露与外在社会支持可链式中介调节女性盆底功能障碍患者由病耻感而来的述情障碍：一项横断面研究［J］.陆军军医大学学报，2026，48（19）：2809-2818.DOI：10.16016/j.2097-0927.202607038. DOI：

Jiang L，Wang R，Luo Z W，et al.Internal self-disclosure and external social support play chain mediating roles in regulating alexithymia from stigma in female patients with pelvic floor dysfunction： a cross-sectional study［J］.J Army Med Univ，2026，48（19）：2809-2818.DOI：10.16016/j.2097-0927.202607038. DOI：

摘要

目的

盆底功能障碍患者的病耻感不仅直接损害患者的身心健康，还可能通过复杂的内在（心理）和外在（社会）机制影响述情障碍，但二者间的潜在路径尚不明确。本研究基于应激作用过程理论，旨在探讨内在自我表露和外在社会支持在女性盆底功能障碍患者病耻感与述情障碍之间的链式中介效应，以期为制定内在心理和外在社会双重维度干预策略、提升心理健康提供科学依据。

方法

采用横断面研究设计，通过便利抽样法选取2025年12月至2026年4月在新疆医科大学第一附属医院妇科和泌尿盆底综合治疗区就诊的450例女性盆底功能障碍患者作为研究对象。采用一般资料调查表、多伦多述情障碍量表、社会影响量表、痛苦表露指数量表和社会支持评定量表测量人口学与临床特征、述情障碍、病耻感、自我表露和社会支持。采用 Pearson 相关分析检验述情障碍、病耻感、自我表露和社会支持间的相关性，并采用Bootstrap法检验链式中介效应。

结果

最终纳入有效问卷450份，有效回收率为96.8%。450例女性盆底功能障碍患者述情障碍、病耻感、自我表露、社会支持得分分别为（63.55±8.02）、（55.59±7.08）、（33.20±5.34）、（39.24±6.01）分。相关分析显示，述情障碍与病耻感呈正相关（

=0.421，

0.001），与自我表露、社会支持呈负相关（

=-0.443、-0.480，均

0.001）。控制人口学等相关变量外，分层回归显示：在控制协变量后，病耻感与自我表露（

=-0.179，

0.001）和社会支持（

=-0.168，

0.001）呈负向关联，自我表露与社会支持呈正向关联（

=0.206，

0.001）；病耻感与述情障碍呈正向关联（

=0.271，

0.001），自我表露和社会支持与述情障碍呈负向关联（

=-0.443、-0.414，均

0.001）。自我表露和社会支持在病耻感与述情障碍之间的链式中介效应显著，效应值为0.435（95%

：0.343~0.527）；直接效应值为0.271（95%

：0.188~0.353），占总效应的62.30%；总间接效应值为0.164（95%

：0.104~0.232），占总效应的37.70%；其中自我表露的中介效应值为0.079（95%

：0.038~0.132），占总效应的18.16%；社会支持的中介效应为0.070（95%

： 0.031~0.114），占总效应的16.05%；自我表露和社会支持的链式中介效应值为0.015（95%

：0.005~0.030），占总效应的3.49%。各中介效应95%

均未包含0。

结论

自我表露和社会支持在女性盆底功能障碍患者病耻感与述情障碍间发挥链式中介效应。提示临床护理人员应关注患者病耻感，通过促进患者自我表露、强化社会支持等内在心理与外在社会双重路径开展针对性干预，促进患者心理健康。

Abstract

Objective

Stigma in patients with pelvic floor dysfunction(PFD) not only directly harms patients’ physical and mental health but may also influence alexithymia through complex internal(psychological) and external(social) mechanisms; however

the underlying pathways between them remain unclarified. Based on the stress process theory

this study aims to investigate the chain mediating roles of self-disclosure and social support between stigma and alexithymia among female PFD patients

thereby providing a scientific basis for developing dual-dimensional intervention strategies targeting both internal psychology and external society and for improving mental health.

Methods

A cross-sectional study was conducted on 450 female PFD patients enrolled by convenience sampling who visited our multidisciplinary team of gynecology and urology in our hospital between December 2025 and April 2026. Demographic and clinical characteristics

alexithymia

stigma

self-disclosure

and social support were assessed using a general information questionnaire

Toronto Alexithymia Scale

Social Impact Scale

Distress Disclosure Index

and Social Support Rating Scale

respectively. Pearson correlation analysis was applied to examine the relationships among alexithymia

illness-related stigma

self-disclosure

and social support. Bootstrap method was used to test the chain mediation effects of self-disclosure and social support.

Results

A total of 450 valid questionnaires were recovered

yielding a valid response rate of 96.8%. The mean scores for alexithymia

stigma

self-disclosure

and social support were 63.55±8.02

55.59±7.08

33.20±5.34

and 39.24±6.01

respectively in the cohort. Pearsons correlation analysis showed that alexithymia was positively correlated with stigma (

=0.421

0.001) and negatively with self-disclosure and social support (

r=-

0.443

0.480; both

0.001). After controlling for demographic and other related variables

hierarchical regression analysis showed that stigma was negatively associated with self-disclosure (

0.179

0.001) and social support (

0.168

0.001)

whereas self-disclosure was positively associated with social support (

=0.206

0.001); illness-related stigma was positively associated with alexithymia (

=0.271

0.001)

whereas self-disclosure and social support were negatively associated with alexithymia (

0.443

0.414; both

0.001). The chain mediation effect of self-disclosure and social support between stigma and alexithymia was significant

with an effect value of 0.435 (95%

: 0.343 to 0.527)

and the direct effect value was 0.271 (95%

: 0.188 to 0.353)

accounting for 62.30% of the total effect; the total indirect effect was 0.164 (95%

CI:

0.104 to 0.232)

accounting for 37.70% of the total effect. Among the indirect effects

the mediation effect of self-disclosure was 0.079 (95%

: 0.038 to 0.132)

accounting for 18.16% of the total effect; the mediation effect of social support was 0.070 (95%

CI:

0.031 to 0.114)

accounting for 16.05% of total effect; and the chain mediation effect of self-disclosure and social support was 0.015 (95%

: 0.005 to 0.030)

accounting for 3.49% of the total effect. None of the 95%

for the indirect mediation effects included zero.

Conclusion

Self-disclosure and social support exert a chain mediation effect on the relationship between stigma and alexithymia among female patients with PFD. These findings suggest that clinical nurses should pay attention to patients’ stigma and difficulties in emotional expression and implement targeted interventions through both internal psychological and external social pathways

promoting self-disclosure and strengthening social support

to improve patients’ mental health.

关键词

Keywords

references

Song Y Q ， Deng X ， Hu T ， et al . Chinese mobile health APPs for preventing and managing pelvic floor dysfunction： quality assessment and content analysis ［J］. J Med Internet Res ， 2026 ， 28 ： e80126 . DOI： 10.2196/80126 http://dx.doi.org/10.2196/80126 .

Milsom I ， Nilsson I E K ， Othman J A ， et al . The socioeconomic burden of pelvic floor disorders ［J］. Acta Obstet Gynecol Scand ， 2026 ， 105 （ 7 ）： 1184 - 1190 . DOI： 10.1111/aogs.70264 http://dx.doi.org/10.1111/aogs.70264 .

Peinado-Molina R A ， Hernández-Martínez A ， Martínez-Vázquez S ， et al . Pelvic floor dysfunction： prevalence and associated factors ［J］. BMC Public Health ， 2023 ， 23 （ 1 ）： 2005 . DOI： 10.1186/s12889-023-16901-3 http://dx.doi.org/10.1186/s12889-023-16901-3 .

Min A P ， Zeng D ， Zhang R J ， et al . A cross-sectional investigation on the function of the female pelvic floor in the Sichuan Province， China ［J］. BMC Women’s Health ， 2025 ， 25 （ 1 ）： 203 . DOI： 10.1186/s12905-025-03720-4 http://dx.doi.org/10.1186/s12905-025-03720-4 .

张鹏月，连俊贤，刘志慧，等 . 应激系统理论实施叙事干预改善盆底功能障碍合并尿失禁患者病耻感和自尊及应对方式的研究［J］. 河北医药， 2026 ， 48 （ 2 ）： 251 - 255 . DOI： 10.3969 / j.issn.1002-7386.2026.02.015 http://dx.doi.org/10.3969/j.issn.1002-7386.2026.02.015 .

Zhang P Y ， Lian J X ， Liu Z H ， et al . Narrative interventions based on stress system theory improve stigma， self-esteem and coping style of patients with pelvic floor dysfunction and stress urinary incontinence ［J］. Hebei Med J ， 2026 ， 48 （ 2 ）： 251 - 255 . DOI： 10.3969/j.issn.1002-7386.2026.02.015 http://dx.doi.org/10.3969/j.issn.1002-7386.2026.02.015 .

Prizeman K ， Weinstein N ， McCabe C . Effects of mental health stigma on loneliness， social isolation， and relationships in young people with depression symptoms ［J］. BMC Psychiatry ， 2023 ， 23 （ 1 ）： 527 . DOI： 10.1186/s12888-023-04991-7 http://dx.doi.org/10.1186/s12888-023-04991-7 .

刘红秀，蔡立柏，崔妙然，等 . 全膝关节置换术后恐动症患者述情障碍现状及影响因素分析［J］. 中华现代护理杂志， 2025 ， 31 （ 29 ）： 3968 - 3975 . DOI： 10.3760/cma.j.cn115682-20241128-06554 http://dx.doi.org/10.3760/cma.j.cn115682-20241128-06554 .

Liu H X ， Cai L B ， Cui M R ， et al . Current status and influencing factors of alexithymia in patients with kinesiophobia after total knee arthroplasty ［J］. Chin J Mod Nurs ， 2025 ， 31 （ 29 ）： 3968 - 3975 . DOI： 10.3760/cma.j.cn115682-20241128-06554 http://dx.doi.org/10.3760/cma.j.cn115682-20241128-06554 .

杨佳，李红梅，张俊，等 . 应激作用过程理论视域下乳腺癌患者生活满意度影响因素的路径分析［J］. 军事护理， 2023 ， 40 （ 07 ）： 43 - 46 . DOI： 10.3969/j.issn.2097-1826.2023.07.010 http://dx.doi.org/10.3969/j.issn.2097-1826.2023.07.010 .

Yang J ， Li H M ， Zhang J ， et al . Path analysis on influencing factors of life satisfaction among breast cancer patients from the perspective of stress processing theory ［J］. Mil Nurs ， 2023 ， 40 （ 07 ）： 43 - 46 . DOI： 10.3969/j.issn.2097-1826.2023.07.010 http://dx.doi.org/10.3969/j.issn.2097-1826.2023.07.010 .

魏贤，邱欢，张雯，等 . 领悟社会支持和心理弹性在肺癌化疗患者病耻感与孤独感之间的链式中介效应［J］. 现代医学， 2025 ， 53 （ 4 ）： 570 - 578 . DOI： 10.3969/j.issn.1671-7562.2025.04.007 http://dx.doi.org/10.3969/j.issn.1671-7562.2025.04.007 .

Wei X ， Qiu H ， Zhang W ， et al . The chain mediating effect of perceived social support and psychological resilience on the relationship between stigma and loneliness in lung cancer patients undergoing chemotherapy ［J］. Mod Med J ， 2025 ， 53 （ 4 ）： 570 - 578 . DOI： 10.3969/j.issn.1671-7562.2025.04.007 http://dx.doi.org/10.3969/j.issn.1671-7562.2025.04.007 .

张亚亚，侯佳文，毕晓玄，等 . 女性盆底功能障碍病人述情障碍现状及影响因素［J］. 护理研究， 2023 ， 37 （ 3 ）： 554 - 559 . DOI： 10.12102/j.issn.1009-6493.2023.03.033 http://dx.doi.org/10.12102/j.issn.1009-6493.2023.03.033 .

Zhang Y Y ， Hou J W ， Bi X X ， et al . Status quo and influencing factors of alexithymia in female patients with pelvic floor dysfunction ［J］. Chin Nurs Res ， 2023 ， 37 （ 3 ）： 554 - 559 . DOI： 10.12102/j.issn.1009-6493.2023.03.033 http://dx.doi.org/10.12102/j.issn.1009-6493.2023.03.033 .

张丹，陈菊娣，冯丽梅 . 老年HIV/AIDS患者侵入性反刍性沉思在自我表露与述情障碍间的中介作用［J］. 中国艾滋病性病， 2025 ， 31 （ 10 ）： 1081 - 1086 . DOI： 10.13419/j.cnki.aids.2025.10.06 http://dx.doi.org/10.13419/j.cnki.aids.2025.10.06 .

Zhang D ， Chen J D ， Feng L M . Mediating effect of intrusive rumination on relationship between self-disclosure and alexithymia among older patients with HIV/AIDS ［J］. Chin J AIDS STD ， 2025 ， 31 （ 10 ）： 1081 - 1086 . DOI： 10.13419/j.cnki.aids.2025.10.06 http://dx.doi.org/10.13419/j.cnki.aids.2025.10.06 .

Gan Y Q ， Tian F X ， Fan X X ， et al . A study of the relationship between social support， depression， alexithymia and glycemic control in patients with type 2 diabetes mellitus： a structural equation modeling approach ［J］. Front Endocrinol ， 2024 ， 15 ： 1390564 . DOI： 10.3389/fendo.2024.1390564 http://dx.doi.org/10.3389/fendo.2024.1390564 .

Rodríguez-Almagro J ， Hernández Martínez A ， Martínez-Vázquez S ， et al . A qualitative exploration of the perceptions of women living with pelvic floor disorders and factors related to quality of life ［J］. J Clin Med ， 2024 ， 13 （ 7 ）. DOI： 10.3390/jcm13071896 http://dx.doi.org/10.3390/jcm13071896 .

Sun F F ， Wang F ， Hu X J ， et al . Alexithymia and negative emotions among nursing students： a moderated mediation model ［J］. BMC Nurs ， 2024 ， 23 （ 1 ）： 167 . DOI： 10.1186/s12912-024-01832-0 http://dx.doi.org/10.1186/s12912-024-01832-0 .

Sidhu T K ， Mahajan R . Decoding the Magic Number： Everyone Can do it！［J］. Int J Appl Basic Med Res ， 2022 ， 12 （ 2 ）： 71 - 75 . DOI： 10.4103/ijabmr.ijabmr_211_22 http://dx.doi.org/10.4103/ijabmr.ijabmr_211_22 .

朱兰，郎景和 . 女性盆底学［M］. 北京：人民卫生出版社， 2008 ： 57 .

Zhu L ， Lang J H . Female pelvic floor medicine ［M］. Beijing ： People’s Medical Publishing House ， 2008 ： 57 .

Bagby R M ， Taylor G J ， Parker J D A . The Twenty-item Toronto Alexithymia Scale-Ⅱ. Convergent， discriminant， and concurrent validity ［J］. J Psychosom Res ， 1994 ， 38 （ 1 ）： 33 - 40 . DOI： 10.1016/0022-3999（94）90006-x http://dx.doi.org/10.1016/0022-3999（94）90006-x .

Fife B L ， Wright E R . The dimensionality of stigma： a comparison of its impact on the self of persons with HIV/AIDS and cancer ［J］. J Health Soc Behav ， 2000 ， 41 （ 1 ）： 50 - 67 .

Kahn J H ， Hessling R M . Measuring the tendency to conceal versus disclose psychological distress ［J］. J Soc Clin Psychol ， 2001 ， 20 （ 1 ）： 41 - 65 . DOI： 10.1521/jscp.20.1.41. 2254 http://dx.doi.org/10.1521/jscp.20.1.41.2254 .

肖水源 . 《社会支持评定量表》的理论基础与研究应用［J］. 临床精神医学杂志， 1994 ，（ 2 ）： 98 - 100 .

Xiao S Y . Theoretical basis and research applications of the Social Support Rating Scale ［J］. J Clin Psychol Med ， 1994 ，（ 02 ）： 98 - 100 .

Wang Y R ， Miao X L ， Viwattanakulvanid P . Effects of a therapeutic lifestyle modification intervention on cardiometabolic health， sexual functioning and health-related quality of life in perimenopausal Chinese women： protocol for a randomised controlled trial ［J］. BMJ Open ， 2024 ， 14 （ 4 ）： e082944 . DOI： 10.1136/bmjopen-2023-082944 http://dx.doi.org/10.1136/bmjopen-2023-082944 .

张子轩，杜华，赵枢驰，等 . 照顾负担通过心理资本与社会网络的链式中介效应降低老年肿瘤患者老老照护者照护能力：一项横断面研究［J］. 陆军军医大学学报， 2026 ， 48 （ 16 ）： 2300 - 2309 . DOI： 10.16016/j. 2097-0927. 202604063 http://dx.doi.org/10.16016/j.2097-0927.202604063 .

Zhang Z H ， Du H ， Zhao S C ， et al . Caregiving burden reduces caregiving ability among older adult caregivers of older cancer patients through the chain mediating effect of psychological capital and social network： a cross-sectional study ［J］. J Army Med Univ ， 2026 ， 48 （ 16 ）： 2300 - 2309 . DOI： 10. 16016/j. 2097-0927. 202604063 http://dx.doi.org/10.16016/j.2097-0927.202604063 .

Li Y K ， Wang H X . Potential profiling of social alienation in older female patients with stress urinary incontinence ［J］. Front Public Health ， 2024 ， 12 ： 1496539 . DOI： 10.3389/fpubh.2024.1496539 http://dx.doi.org/10.3389/fpubh.2024.1496539 .

付凯然 . 自我表露干预联合强化盆底肌训练对前列腺癌术后尿失禁患者的影响［J］. 医疗装备， 2025 ， 38 （ 1 ）： 134 - 137 .

Fu K R . Effects of self-disclosure intervention combined with intensified pelvic floor muscle training on urinary incontinence in patients after prostate cancer surgery ［J］. Med Equip ， 2025 ， 38 （ 01 ）： 134 - 137 .

邵佩，杜娟，董笑雨，等 . 社会支持在军队医院护理人员焦虑和生活质量中的中介效应［J］. 职业卫生与应急救援， 2025 ， 43 （ 3 ）： 330 - 335 . DOI： 10.16369/j.oher.issn.1007-1326.2025.240496 http://dx.doi.org/10.16369/j.oher.issn.1007-1326.2025.240496 .

Shao P ， Du J ， Dong X Y ， et al . Mediating effect of social support on relationship between anxiety and quality of life among nursing staff in military hospitals ［J］. Occup Health Emerg Rescue ， 2025 ， 43 （ 03 ）： 330 - 335 . DOI： 10.16369/j.oher.issn.1007-1326.2025.240496 http://dx.doi.org/10.16369/j.oher.issn.1007-1326.2025.240496 .

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