Ego strength and health: An empiric study in hemodialysis patients

Salvatore Settineri, Carmela Mento, Domenico Santoro, Agostino Mallamace, Guido Bellinghieri, Vincenzo Savica, Biagio Ricciardi, Santina Castellino, Domenico Mallamace

Department Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina, Italy.
Department of Human and Social Sciences, University of Messina, Messina, Italy.
Department of Nephrology, University of Messina, Messina, Italy.
Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, Division of Psychiatry, University of Messina, Messina, Italy.
Nephrology and Dialysis Units, Papardo Hospital, Messina, Italy.
Researcher in Nephrology, Department of Internal Medicine, University of Messina, Messina, Italy.
Unit of Nephrology, ASP5 Milazzo Hospital, Milazzo, Italy.
Unit of Nephrology, ASP5 Taormina Hospital, Taormina, Italy.

DOI: 10.4236/health.2012.412194                

Abstract

Introduction: Ego strength represents an important variable that could be predictable about health and compliance in chronic diseases. In this study we propose a new questionnaire, E.F.E. “Ego Functioning Experience”, able to reveal the psychological functioning profile in Hemodialysis patients. The aim of this work, is to underline the existing relations between emotional profile and compliance, whit E.F.E., that may be predictive of a state of psychologycal health in hemodialysis patients. Methods: Study population included 90 hemodialysis patients. The study protocol was made by three psychological tests: the E.F.E. Questionnaire, the DMI, the Self-Liking and Self-Competence Scale. Results: Factor analysis extracts three factors: 1) “Need of Ego support”; 2) “Ego activity oriented to treatment”; 3) “Ego strength”. The correlation coefficients between the E.F.E. Questionnaire factors (three factors) and other measures, showed a direct correlation with the first factor and “turning against object” TAO of the DMI test (correlation is significant at the 0.001 level) and an inverse relation with set mechanisms of “Principalization”, PRN of the DMI (correlation is significant at the 0.005 level). The correlations of the second and the third factors with other measures, were not statistically significant. No relations were found about other variables. Conclusions: The E.F.E. questionnaire is a simple evaluation to detect hemo-dialysis patients who may need greater attention to the psychological health and therefore the need for treatment such as psychological support. In fact, lower presence of ego strength is indicative of poor compliance to clinical treatment in hemodialysis, but also of worsening of psychiatric symptoms such as demoralization and depressed mood. In conclusion, an increased social support is needed in hemodialysis patient in order to achieve better compliance and achieve a better state of psychological health in chronic hemodialysis patients.

Keywords

Hemodialysis; Compliance; Ego Strenght; Emotional States

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Vaillant, G.E. (1971) Theoretical hierarchy of adaptive ego mechanisms. Archives of General Psychiatry, 24, 107-118. doi:10.1001/archpsyc.1971.01750080011003
[2]	Lazarus, R.S. (1991) Emotion and adaptation. Oxford University Press, New York.
[3]	Hillman, J. (1999) The force of character. Random House, New York.
[4]	LeDoux, J. (1996) The emotional brain: the mysterious underpinnings of emotional life. Simon and Schuster, New York.
[5]	Sanz Guajardo, D., Orte, L., Gomez-Compderà, F., Fernandez, E., Aguilar, M.D., Làzaro, P. and Inesir, Group. (2006) Quality of life in patients with chronic renal failure influence of nephrologist’s early intervention and predialysis clinical visit consultation. Nephrology, 26, 56-65.
[6]	Sayin, A., Mutluay, R. and Sindel, S. (2007) Quality of life in hemodialysis, peritoneal dialysis and transplantation patients. Transplantation Proceedings, 39, 3047- 3053. doi:10.1016/j.transproceed.2007.09.030
[7]	Friend, R., Hatchett, L., Shneider, M.S. and Wadhwa, N.K. (1997) A comparision of attributions, heath beliefs and negative emotions as predictors of fluid adherence in renal dialysis patients: A prospective analysis. Annals of Behavioral Medicine, 19, 344-347. doi:10.1007/BF02895152
[8]	Rogers, C. (1951) Client-centered therapy: Its current practice, implications and theory. Constable, London.
[9]	Folkman, S. and Moskowitz, J.T. (2000) Positive affect and the other side of coping. American Journal of Psychology, 55, 647-654. doi:10.1037/0003-066X.55.6.647
[10]	Fowler, C. and Baas, L.S. (2006) Illness representations in patients with chronic kidney disease on maintenance haemodialysis. Nephrology Nursing Journal, 33, 173-174, 179-186.
[11]	Dvison, S.N. (2007) The prevalence and management of chronic pain in end-stage renal disease. Journal Palliative Medicine, 10, 1277-1287. doi:10.1089/jpm.2007.0142
[12]	Zoccali, R., Bellinghieri, G., Mallamace, A., Muscatello, M.R.A., Bruno, A., Santoro, D., Mallamace, D., Barillà, G.P., Scardamaglia, P., La Torre, D. and Meduri, M. (2006) Defence mechanisms in hemodialysis, dependent patients. Clinical Nephrology, 65, 119-123.
[13]	Cukor, D., Cohen, S.D., Petersonr, A. and Kimmel, P.L. (2007) Psychosocial aspects of chronic disease: ESRD as a paradigmatic illness. Journal of the American Society of Nephrology, 18, 3042-3055. doi:10.1681/ASN.2007030345
[14]	Livneh, H. and Antonak, R.F. (1997) Psychosocial adaptation to chronic illness and disability. Aspen Publishers, Giathersburg.
[15]	Thong, M.S.Y., Kaptein A.A., Krediet, R.T., Boeschoten, E.W. and Dekker, F.W. (2007) Social support predicts survival in dialysis patients. Nephrology Dialysis Transplantation, 22, 845-850. doi:10.1093/ndt/gfl700
[16]	Patel, S.S., Shah, V.S., Peterson, R.A. and Kimmel, P.L. (2002) Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. American Journal of Kidney Disease, 40, 1013-1022. doi:10.1053/ajkd.2002.36336
[17]	Symister, P. and Friend, R. (2003) The influence of social support and problematic support on optimism and depression in chronic illness: A prospective study evaluating self-esteem as a mediator. Health Psychology, 22, 123-129. doi:10.1037/0278-6133.22.2.123
[18]	Timmers, L., Thong, M., Dekker, F.W., Boeschoten, E.W., Heijmans, M., Rijken, M., Weinman, J. and Kaptein, A. (2008) Illness perceptions in dialysis patients and their association with quality of life. Psychology & Health, 23, 679-690. doi:10.1080/14768320701246535
[19]	The Diabetes Research in Children Network (DirecNet) Study Group (2006) Psychological aspects of continuous glucose monitoring in pediatric type 1 diabetes. Pediatric Diabetes, 7, 32-38. doi:10.1111/j.1399-543X.2006.00142.x
[20]	Bagby, R.M., Quilty, L.C. and Ryder, A.C. (2008) Personality and depression. Canadian Journal of Psychiatry, 53, 14-25.
[21]	Rothbaum, F., Morling, B. and Rusk, N. (2009) How goals and beliefs lead people into and out of depression. Review of General Psychology, 13, 302-314. doi:10.1037/a0017140
[22]	Wisco, B.E. (2009) Depressive cognition: Self-reference and depth of processing. Clinical Psychology Review, 29, 382-392. doi:10.1016/j.cpr.2009.03.003
[23]	Gotlib, I.H. and Joormann, J. (2010) Cognition and depression: Current status and future directions. Annual Review of Clinical Psychology, 6, 285-312. doi:10.1146/annurev.clinpsy.121208.131305
[24]	Chan, R., Brooks, R., Erlich, J., Gallagher, M., Snelling, P., Chow, J. and Suranyi, M. (2011) Studying psychosocial adaptation to end-stage renal disease: The proximaldistal of health-related outcomes as a base model. Journal of Psychosomatic Research, 70, 455-464. doi:10.1016/j.jpsychores.2010.11.005
[25]	Folkman, S. (2008) The case for positive emotions in the stress process. Anxiety Stress Coping, 21, 3-14. doi:10.1080/10615800701740457
[26]	Fredrickson, B.L. (2006) Unpacking positive emotions: Investigating the seeds of human flourishing. Journal of Positive Psychology, 1, 57-59. doi:10.1080/17439760500510981
[27]	Rabkin, J.G., Mcelhiney, M., Moran, P., Acree, M. and Folkman, S. (2009) Depression, distress and positive mood in late-stage cancer: a longitudinal study. Psycho Oncology, 18, 79-86. doi:10.1002/pon.1386
[28]	Chan, R., Steel, Z., Brooks, R., Heung, T., Erlich, J., Chow, J. and Suranyi, M. (2011b) Psychosocial risk and protective factors for depression in the dialysis population: A systematic review and meta-regression analysis. Journal of Psychosomatic Research, 71, 300-310. doi:10.1016/j.jpsychores.2011.05.002
[29]	Browne, T. and Merighi, J.R. (2010) Barriers to adult hemodialysis patients’ self-management of oral medications. American Journal Kidney Disease, 56, 547-557.
[30]	Marsch, C.M., Goncalves, L.F. and Barras, E. (2006) Healt-related quality of life among haemo-dialysis patients relationship with clinical indicators, morbility and mortality. Journal of Clinical Nursing, 15, 498-504. doi:10.1111/j.1365-2702.2006.01349.x
[31]	Ihilevich, D. and Gleser, G.C. (1986) Defence mechanisms. Their classification, correlates, and measurement with the defence mechanim inventory. DMI Association Ossowo.
[32]	Fioriti, G. and Gentili, P. (1994) Defence mechanism inventory. Italian Version. OS, Giunti.
[33]	Tafarodi, R.W. and Swann W.B. Jr. (1995) Self-liking and self-competence as dimensions of global self-esteem: Validation of a measure. Journal of Personality Assessment, 65, 322-42. doi:10.1207/s15327752jpa6502_8
[34]	Pedhazur, E.J. and Schmelkin, L.P. (1991) Measurement, design, and analysis: An integrated approach. Lawrence Erlbaum Associates, Hillsdale.
[35]	Johnson, S. and Dwyer, A. (2008) Patient perceived barriers to treatment of depression and anxiety in hemodyalisis patients. Clinical Nephrology, 69, 201-206.
[36]	Taskapan, H., Ates, F., Kaya, B., Emul, M., Kaya, M., Taskapan, C. and Sahin, I. (2005) Psychiatric disorders and large interdialytic weight gain in patients on chronic hemodialysis. Nephrology (Carlton), 10, 15-20. doi:10.1111/j.1440-1797.2005.00321.x
[37]	Baris, A. and Beril, A. (2009) Depression and nonadherence are closely related in dialysis patients. Kidney International, 76, 679.
[38]	Cukor, D., Rosenthal, D.S., Jindal, R.M., Brown, C.D. and Kimmel, P.L. (2009) Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney International, 75, 1223-1229. doi:10.1038/ki.2009.51