BACKGROUND: Depressive symptoms are common among kidney transplant recipients and are linked to adverse clinical and psychosocial outcomes. Chronotype may influence vulnerability to stress and emotional dysregulation, yet its psychosocial pathways to depression remain unclear. This study tested a stress process model to explain how chronotype, as a background factor, affects depressive symptoms through perceived stress, rumination, and sleep quality.
METHODS: A multicenter cross-sectional study involving 508 kidney transplant recipients was conducted in southern China. Participants completed validated questionnaires assessing chronotype, perceived stress, rumination, sleep quality, and depressive symptoms. Structural equation modeling examined direct and indirect pathways among variables.
RESULTS: The findings supported the hypothesized structural equation model. The total indirect effect of chronotype on depressive symptoms exceeded its direct effect. Significant indirect effects were observed through perceived stress (β = -0.14, 95 % CI [-0.28, -0.04]), rumination (β = -0.09, 95 % CI [-0.18, -0.01]), and sleep quality (β = -0.05, 95 % CI [-0.11, -0.03]), as well as sequential mediations involving perceived stress with rumination or sleep quality. In the extended model, the indirect pathways through perceived stress and reflection (β = -0.04, 95 % CI [-0.08, -0.01]) and through perceived stress, brooding, and sleep quality (β = -0.03, 95 % CI [-0.05, -0.01]) remained significant.
CONCLUSIONS: These findings highlight the need to incorporate chronotype assessment into post-transplant care. Interventions should emphasize circadian rhythm regulation, stress reduction, disruption of maladaptive rumination, and sleep improvement to prevent depressive symptoms among kidney transplant recipients.
