Psychological factors in end-stage renal disease: An emerging context for behavioral medicine research.

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Abstract

End-stage renal disease (ESRD) is a chronic, life-threatening condition afflicting over 300,000 Americans. Patient nonadherence and psychological distress are highly prevalent among ESRD patients, and both have been found to contribute to greater morbidity and earlier mortality in this population. A range of factors have been examined as potential determinants of adherence and adjustment. Evidence suggests that adherence and adjustment are maximized when a patient's preferred style of coping is consistent with the contextual features or demands of the renal intervention the patient is undergoing. Challenges for future clinical research include refining methodologies for the assessment of depression and adherence, more clearly evaluating the efficacy of psychological interventions, and clarifying the role that depression and social support play in influencing patient mortality.

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Distinctions between social support concepts, measures, and models

Manuel Barrera (1986)

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Monitoring and blunting: validation of a questionnaire to assess styles of information seeking under threat.

Suzanne Miller (1987)

Subjects were divided into information seekers (high monitors)/information avoiders (low monitors) and distractors (high blunters)/nondistractors (low blunters) on the basis of their scores on a self-report scale to measure coping styles, the Miller Behavioral Style Scale (MBSS). In Experiment 1, subjects were faced with a physically aversive event (the prospect of electric shock). High monitors and low blunters chose to seek out information about its nature and onset whereas low monitors and high blunters chose to distract themselves. This effect was strongest with the blunting dimension. High monitoring and low blunting were also accompanied by sustained high anxiety and arousal. In contrast, low monitors and high blunters were able to relax themselves over time. In Experiment 2, subjects worked on a series of tests that presumably predicted success in college. They could attend as often as they wished to a light that signaled how well they were performing. Results showed that coping-style scores accurately predicted informational strategy, particularly with the monitoring dimension: High monitors tended to look at the light whereas low monitors tended to ignore it. Thus the MBSS measure of coping styles appears to be a valid instrument for predicting behavioral strategies in response to both physical and psychological stressors. The theoretical and practical implications of these findings are discussed.

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Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives.

Neil Jacobson, Lisa Roberts, Sara Berns … (1999)

This article summarizes and scrutinizes the growth of the development of clinically relevant and psychometrically sound approaches for determining the clinical significance of treatment effects in mental health research by tracing its evolution, by examining modifications in the method, and by discussing representative applications. Future directions for this methodology are proposed.