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22 June 2015 : Clinical Research  

Denial Defense Mechanism in Dialyzed Patients

Zbigniew NowakABCDEF, Zofia WańkowiczABCDEF, Krzysztof LaudanskiABCDEFG

DOI: 10.12659/MSM.893331

Med Sci Monit 2015; 21:1798-1805

Abstract

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.

Keywords: Affect - physiology, Adaptation, Psychological - physiology, Albumins - metabolism, Anxiety - etiology, Calcium - blood, Cohort Studies, Creatinine - blood, Cross-Sectional Studies, Denial (Psychology), Hematocrit, Kidney Failure, Chronic - psychology, Peritoneal Dialysis, Continuous Ambulatory - psychology, Phosphorus - blood, Potassium - blood, Quality of Life - psychology, Renal Dialysis - standards, Urea - blood

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750