Current Landscape and Multidimensional Determinants of Spiritual Coping Mechanisms Among Tuberculosis Patients in Zhejiang, China: A Population-Based Cross-Sectional Investigation.

Abstract

Aim: Investigate the different spiritual coping strategies employed by tuberculosis patients during their illness and determine the multidimensional determinants influencing these adaptive strategies.

Design: Online cross-sectional design.

Methods: Between January and September 2024, 448 tuberculosis (TB) patients in Zhejiang Province, China, were recruited via WeChat-based outreach. Data collection was implemented through a digitally administered, self-report survey platform. Comprehensive statistical analyses were performed, including independent samples t-tests, one-way ANOVA for group comparisons, Pearson correlation coefficients for bivariate associations, and hierarchical multiple linear regression modeling to identify predictor clusters. This cross-sectional investigation rigorously adhered to the STROBE guidelines throughout its design, execution, and reporting phases.

Results: Among the 448 patients, 255 were male and 193 were female, with an average age of 47.45 (SD = 18.23) years. The factors influencing the level of Positive Spiritual Coping (PSC) were sex (t = -2.593, p = 0.010), residence (t = 2.317, p = 0.021), marital status (t = -2.485, p = 0.013), and economic indicators (F = 2.951, p = 0.032). The factors influencing the level of Negative Spiritual Coping (NSC) were age (F = 3.226, p = 0.041), marital status (t = 2.635, p = 0.009), alcohol consumption (t = 2.840, p = 0.005), number of children (t = 2.022, p = 0.044), and TB diagnosis type (t = -2.323, p = 0.021). The PSC level was negatively correlated with depression (p < 0.01) and positively correlated with the Brief Resilience Scale (BRS), Family APGAR Index (APGAR), and Personal Mastery Scale (PMS) (p < 0.01). The NSC level was positively correlated with depression, anxiety, and stress (p < 0.01) and negatively correlated with BRS, APGAR, and PMS (p < 0.01). Multivariate linear regression analysis indicated that PMS (2.852, P=0.005), APGAR (3.740, P<0.0001), BRS (3.457, P=0.001), and gender (3.343, P=0.001) significantly affected the PSC level in TB patients. Depression (10.112, P < 0.0001), APGAR (-4.571, P < 0.0001), BRS (-3.084, P = 0.002), number of children (-2.315, P = 0.021), and type of TB diagnosis (2.217, P = 0.027) were factors that independently affected the NSC level of TB patients.

Conclusion: TB patients exhibit better PSC levels in female patients, and higher PMS, BRS, and APGAR levels correlate with higher PSC levels. NSC levels are higher in patients without children and pulmonary TB, while higher BRS and APGAR levels are associated with lower NSC levels. These findings can help healthcare providers tailor person-centered spiritual care strategies for TB patients based on factors influencing spiritual coping, thereby improving their mental health during illness, reducing psychological distress, and facilitating earlier recovery.