Denial Defense Mechanism in Dialyzed Patients

BACKGROUND

It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including denial, in patients with end-stage renal disease (ESRD), varies with type of renal replacement therapy (RRT).

MATERIAL AND METHODS

We enrolled 60 in-center hemodialyzed patients (HD) and 55 patients treated with continuous ambulatory peritoneal dialysis (CAPD). We administered the Coping Inventory with Stressful Situation, Profile of Mood States, and Stroop Anxiety Inventory to measure patient coping strategies in the context of their ESRD. Denial defense mechanism was measured via the IBS-R/ED. The Nottingham Health Profile was used to evaluate self-perceived quality of life. Serum potassium, urea, creatinine, phosphorus, calcium, albumin, and hematocrit were utilized as the measurements of adequacy of dialysis.

RESULTS

HD patients had higher self-reported intensity of denial mechanism and avoidance-oriented strategies versus CAPD patients. Because a single strategy is almost never employed, we conducted cluster analysis. We identify 3 patterns of coping strategies using cluster analysis. "Repressors" employed denial and avoidance strategies and were predominant in HD. The second cluster consists of subjects employing predominantly task-oriented strategies with equal distribution among dialyzed patients. The third cluster encompassed a small group of patients who shared higher intensity of both denial and task-oriented strategies. Health-related outcome, anxiety, and mood profile were similar across all patients.

CONCLUSIONS

HD patients predominantly used "repressive" strategies. Patients on RRT utilized denial and avoidance-based strategies to achieve satisfactory outcome in terms of perceived quality of life. We conclude that these coping mechanisms that were previously thought to be inferior are beneficial to patient compliance with RRT.

Longitudinal Changes in Coping for Spouses of Post–Myocardial Infarction Patients

Spouses are the key in the recovery and coping of patients after a myocardial infarction (MI). The purpose of this study was to examine changes in coping for spouses of post-MI patients over time. The study determined the contributions of a spouse’s demographic factors and of time since the MI to the changes in coping. A secondary data analysis from the Patients’ and Families’ Psychological Response to Home Automated External Defibrillator Trial was conducted. On average, older spouses coped better than younger spouses. Coping significantly decreased over time. The spouse’s coping decreased for spouses whose baseline coping was higher. Coping decreased more rapidly for spouses of patients who experienced an MI more recently. Patients and spouses need support to improve coping after an MI.