Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables.</p> <p>Methods</p> <p>The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style.</p> <p>Results</p> <p>Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant.</p> <p>Conclusions</p> <p>The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.</p

Psychosocial dimensions of chronic kidney disease

Chronic kidney disease (CKD) is a life-threatening condition that necessitates life-long pharmacological treatment and dietary restrictions. End-stage kidney disease engenders additional constraints due to the vital need for regular sessions of renal dialysis. On these grounds, CKD has been defined as provoking a state of prolonged distress. Coping with the stresses of the disease embraces several psychological defenses and reveals patients’ attachment style. These psychological characteristics have been associated with the course of chronic illness and patients’ adjustment. However, little evidence exists for these associations in CKD. The present study was motivated by certain clinical hypotheses that have been formulated within the frameworks of the Psychonephrology Unit at the University of Ioannina Hospital. Its aim was to investigate the association of psychological defenses and attachment style with health-related quality of life (HQoL), which has been considered as a key factor in CKD prognosis. A cross-sectional design was employed to enable comparisons among patients in different CKD stages (N=98) and a control group of Essential Hypertension (EH) patients (N=68). Short-Form health survey (SF-36), Response Evaluation Measure (REM-71), Lifestyle Defense Mechanism Inventory (LDMI) and Experiences in Close Relationships Inventory (ECRI) were all used to evaluate patients. To control for common risk factors, psychological distress was also assessed (SCL-90-R), while demographic and disease-related variables were collected. Compared to EH patients, CKD patients had significantly lower scores on physical aspects of HQoL (OddsRatio(1,01-1,20)=1,104, p=0,027) and significantly higher scores on dysfunctional defenses (e.g. splitting, projection, etc.) (OddsRatio(0,10-0,63)=0,253, p=0,003). The fully adjusted analysis showed that a higher score on dysfunctional defenses was significantly associated with a lower score on mental aspects of health-related quality of life in both CKD (β=-5,561, p=0,000) and EH (β=-2,638, p=0,044). However, a higher score on emotional defensiveness (repression and denial) had a marginally significant association with a higher score on physical aspects for CKD patients (β=0,396, p=0,027) but not for EH patients. Attachment style was nonsignificantly associated with physical and mental aspects of HQoL in CKD, although an insecure attachment style was found. Results suggested that CKD and EH patients differed in terms of psychological development. They also provided evidence for a distinct impact of psychological defensiveness on different aspects of HQoL in CKD. Although liable to certain limitations, the present findings posed several issues to consider in both clinical practice and future research.Ο χρόνιος και απειλητικός για τη ζωή χαρακτήρας της Νεφρικής Νόσου, καθώς και η πολυπλοκότητα των θεραπευτικών μεθόδων στο τελικό στάδιο επιφέρουν σημαντικούς περιορισμούς και πιέσεις στο άτομο που νοσεί. Η διαχείριση αυτών των πιέσεων συνοδεύεται από την κινητοποίηση των μηχανισμών άμυνας του ψυχισμού και αναδεικνύει τα δομικά χαρακτηριστικά των σχέσεων εγγύτητας. Τα ψυχολογικά αυτά χαρακτηριστικά έχουν συσχετιστεί με την πορεία της χρόνιας ασθένειας και το επίπεδο προσαρμογής των ασθενών αλλά δεν έχουν εξεταστεί στη Χρόνια Νεφρική Νόσο (ΧΝΝ). Αυτή η περιορισμένη γνώση αλλά και τα κλινικά ερωτήματα που προέκυψαν στη Μονάδα Ψυχονεφρολογίας του Πανεπιστημιακού Νοσοκομείου Ιωαννίνων, έδωσαν το έναυσμα για το σχεδιασμό της παρούσας ερευνητικής μελέτης. Σκοπός της ήταν να διερευνήσει την αλληλεξάρτηση των ψυχολογικών αμυνών και των σχέσεων εγγύτητας σε συνάφεια με την ποιότητα ζωής, η οποία συνιστά σημαντικό προγνωστικό δείκτη στη ΧΝΝ. Η συγχρονική μέθοδος υιοθετήθηκε για τη μελέτη ασθενών με ΧΝΝ όλων των σταδίων (Ν=98) συγκριτικά με ομάδα ελέγχου, αποτελούμενη από ασθενείς με Ιδιοπαθή Αρτηριακή Υπέρταση (ΙΑΥ) (Ν=68). Για την ψυχομετρική αξιολόγηση χρησιμοποιήθηκαν η Επισκόπηση Υγείας (SF-36), η Κλίμακα του Τύπου Ψυχολογικής Άμυνας (REM-71), το Ερωτηματολόγιο Μελέτης των Μηχανισμών Άμυνας (LDMI) και η Κλίμακα Βιωμάτων στις Κοντινές Σχέσεις (ECRI). Προκειμένου να ελεγχθεί η επίδραση γνωστών παραγόντων κινδύνου, αξιολογήθηκε η ψυχική υγεία (SCL-90-R) και συλλέχθηκαν οι δημογραφικές και οι σχετιζόμενες με τη νόσο πληροφορίες. Οι ασθενείς με ΧΝΝ είχαν στατιστικά σημαντικά χαμηλότερη σωματική ευεξία (OddsRatio(1,01-1,20)=1,104, p=0,027) και μεγαλύτερη χρήση δυσλειτουργικών αμυνών (OddsRatio(0,10-0,63)=0,253, p=0,003) από τους ασθενείς με ΙΑΥ. Εφόσον σταθμίστηκε η επίδραση γνωστών παραγόντων κινδύνου, βρέθηκε μια στατιστικά σημαντική θετική συσχέτιση μεταξύ της αμυντικής διαχείρισης των συναισθημάτων (απώθηση και άρνηση) και της σωματικής ευεξίας (β=0,396, p=0,027), η οποία δε διαπιστώθηκε, ωστόσο, στους ασθενείς με ΙΑΥ. Βρέθηκε, επίσης, μια στατιστικά σημαντική αρνητική συσχέτιση μεταξύ των δυσλειτουργικών αμυνών (π.χ. σχάση, προβολή, κ.α.) και της ψυχικής ευεξίας (β=-5,561, p=0,000), η οποία επιβεβαιώθηκε και στην ομάδα ελέγχου (β=-2,638, p=0,044). Σε αντίθεση με τους ασθενείς ΙΑΥ, οι συσχετίσεις των σχέσεων εγγύτητας με τη σωματική και ψυχική ευεξία των ασθενών ΧΝΝ ήταν στατιστικά μη σημαντικές, αποκάλυπταν δε την παρουσία ανασφαλών δεσμών. Τα ευρήματα ανέδειξαν εξελικτικού τύπου διαφοροποιήσεις σε ψυχικό επίπεδο μεταξύ των δυο ομάδων αλλά και το διττό ρόλο των αμυνών σε σχέση με τη σωματική και την ψυχική ευεξία στη ΧΝΝ. Παρόλο που η αξιοπιστία τους αποτελεί συνάρτηση συγκεκριμένων μεθοδολογικών περιορισμών, αποκάλυψαν μια τάση που αξίζει να ληφθεί υπόψη στην κλινική πρακτική αλλά και σε μελλοντικές έρευνες

Psychometric properties and factor structure of the Greek version of the Cardiac Anxiety Questionnaire (CAQ)

The present study assesses the psychometric properties and factor structure of the Greek version of the Cardiac Anxiety Questionnaire (CAQ). The questionnaire was administered to 598 healthy individuals from 15 different regions of Greece with a measure of socioeconomic characteristics and the Symptom Checklist-90–Revised (SCL-90–R). The sample was split into two random halves, and exploratory factor analysis indicated a three-factor solution. This solution was tested using a confirmatory factor analysis on the second half of the sample. In terms of latent dimensions, the Greek version retains the three-factor structure as proposed by the initial authors. However, adequate fit was achieved only after omitting eight items. The shorter (10-item) version was submitted to further analysis. The shorter version provided satisfactory internal reliability and evidence indicating the validity of the scale with respect to SCL-90–R subscales. The stability of the questionnaire was verified by a high test-retest reliability over a 3-mo. period ( r = .86). Sex and age differences were assessed. The 10-item version appears to be a practical, brief tool for clinical use. </jats:p

Relationship between Kt/V urea-based dialysis adequacy and nutritional status and their effect on the components of the quality of life in incident peritoneal dialysis patients

<p>Abstract</p> <p>Background</p> <p>It is well known that the quality of life of patients with chronic kidney disease can be improved by dialysis. While previous studies have used retrospective designs and adhered to a standard target prescribed by clinical guidelines, our study prospectively investigates the association between the adequacy of peritoneal dialysis (PD) and measures of nutritional status on quality-of-life domains in a cohort of incident PD patients.</p> <p>Methods</p> <p>It was a prospective 6-month observational study. Eighty incident PD participants who were treated in a hospital-based PD center were enrolled. The period of enrollment was January 2009–June 2010; follow-up continued until December 2010. PD adequacy indices, including Kt/V urea, weekly Ccr (WCcr), measures of nutritional status (albumin, BMI), and nPCR were measured at 1 month and 6 months after PD initiation. SF-36 health survey questionnaires were used to measure the quality of life. The outcomes were used to measure the changes in the domains of the SF-36 after 6 months of PD therapy.</p> <p>Results</p> <p>Seventy-seven incident patients who underwent PD for 6 months were included in the study. The mean age was 47.3 years, and the male-to-female ratio was 38:39. A peritoneal Kt/V urea value of 1.2, which was also the baseline cutoff value, was found to have the highest influence on SF-36 domains. Patients with baseline peritoneal Kt/V urea value of <1.2 showed improvement in the physical functioning and role limitation of physical functioning components after 6 months of PD. In contrast, patients with baseline peritoneal Kt/V urea values of ≥1.2 showed remarkable improvement in the general health, physical functioning, role limitation caused by physical problems, and bodily pain components. However, the trend of improvement decreased in patients with baseline nPCR of <1.2. Baseline renal WCcr did not influence the improvement in the SF-36 domains.</p> <p>Limitations</p> <p>A small cohort and a short observation period.</p> <p>Conclusions</p> <p>The baseline level of peritoneal Kt/V urea affected the components of the quality of life after PD initiation. In contrast, a lower baseline nPCR level was associated with deterioration in the quality of life after PD therapy.</p