Alan J. Christensen

Personality and patient adherence: correlates of the five-factor model in renal dialysis.

The five-factor taxonomy of personality traits has received increasing attention in the literature regarding personality correlates of health outcomes and behaviors. We examined the association of the five NEO Five-Factor Inventory dimensions to medical regimen adherence in a sample of 72 renal dialysis patients. Results indicated that Conscientiousness (Dimension III) is a five-factor trait significantly associated with adherence to the medication regimen. No other NEO-FFI dimension was significantly associated with patient adherence.

Predictors of survival among hemodialysis patients: Effect of perceived family support.

The authors examined the role of perceived family support and symptoms of depression as predictors of survival in a sample of 78 in-center hemodialysis patients. Cox regression analysis revealed significant effects for family support (p < .005), blood urea nitrogen (p < .01), and age (p < .005). The effect for depression was not significant. The Cox model indicated that a 1-point increase on the family support measure was associated with a 13% reduction in the hazard rate (i.e., mortality). Estimated 5-year mortality rates among low family support patients were approximately 3 times higher than estimated mortality for high support patients. Differences in patient adherence to the dietary and medication regimens failed to explain the significant effect of family support.

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

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 patients 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.

Cynical hostility and cardiovascular reactivity during self-disclosure

&NA; Recent research suggests that hostility might contribute to the development of coronary heart disease (CHD) and other illnesses. One potential mechanism linking hostility and health is exaggerated physiological reactivity to social stressors. Given that mistrust and suspiciousness are closely related to this trait, the self‐disclosure of personal information regarding a stressful experience may elicit heightened reactivity in hostile persons. To evaluate this hypothesis, undergraduate men (N = 60) classified as high or low on the Cook and Medley Hostility (Ho) Scale were randomly assigned to either a self‐disclosure or a nondisclosure condition. Consistent with prediction, among subjects participating in the self‐disclosure discussion task, hostile individuals displayed significantly greater blood pressure reactivity compared with subjects low in hostility. These results support the psychophysiological reactivity model of hostility and health, and underscore the potential importance of social context in the psychosomatic process.

Family support, physical impairment, and adherence in hemodialysis: An investigation of main and buffering effects

Patient noncompliance is a pervasive problem among end-stage renal disease (ESRD) patients. Previous studies have implicated social support as an important correlate of adherence behavior in other chronic illness groups, but little research has examined this relationship in a hemodialysis population. The present study examined the main and interactive effects of social support in the family and illness-related physical impairment with regard to patient compliance in a sample of 78 hemodialysis patients. Results indicated that patients holding perceptions of a more supportive family environment exhibited significantly more favorable adherence to fluid-intake restrictions than did patients reporting less family support. Family support was not associated with adherence to dietary restrictions. The effect of family support on fluid-intake adherence was not moderated by level of physical impairment. This pattern suggests that the influence of support on adherence is more attributable to a main or direct effect, as opposed to a buffering process in the face of increased physical impairment.

Patient personality and mortality: a 4-year prospective examination of chronic renal insufficiency.

The present study examined the role of personality as a predictor of mortality among patients with chronic renal insufficiency. A prospective evaluation of the influence of personality on patient survival was conducted over an average 49-month period. Cox regression was used to evaluate the effects of 5 dimensions of personality in a sample of 174 patients (100 male and 74 female). At follow-up, 49 patients had died. Significant demographic and clinical predictors of survival included age, diabetic status, and hemoglobin level. After these predictors were controlled for, 2 personality traits, conscientiousness and neuroticism, predicted patient mortality. Patients with high neuroticism scores had a 37.5% higher estimated mortality rate. Patients with low conscientiousness scores had a 36.4% increased mortality rate.

Assessment of irrational health beliefs: Relation to health practices and medical regimen adherence

The purpose of the present research was to provide initial validation of the 20-item Irrational Health Belief Scale (IHBS). Study 1 included 392 undergraduate psychology students. Results from Study 1 suggested that the IHBS total score is internally consistent and stable over an 18-month time period. Greater health-related cognitive distortion (higher IHBS scores) was associated with weaker internal health locus of control beliefs, lower positive affectivity, stronger chance health locus of control beliefs, and greater negative affectivity. Most important, greater cognitive distortion was uniquely and significantly associated with a less positive pattern of health practices. Study 2 involved 107 individuals with Type I diabetes mellitus. Results indicated that higher IHBS scores were significantly associated with both objective (hemoglobin HbA1) and self-reported diabetic regimen adherence independent of trait neuroticism and conscientiousness.

Influence of social support on health-related quality of life outcomes in head and neck cancer.

Evidence that social support influences health‐related quality of life (HRQOL) in oncologic patients could be particularly important for head and neck cancer because this disease can affect speech, eating, and facial aesthetics.

Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individuals level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.

Coping with treatment-related stress: Effects on patient adherence in hemodialysis.

With a modified version of the Ways of Coping Checklist, the relation of coping to adherence among 57 hemodialysis patients was examined. The association of a particular type of coping to adherence was predicted to depend on the specific type of stressful encounter being considered. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts involving emotional self-control were associated with more favorable adherence. The seeking of informational support in response to an uncontrollable encounter was associated with poorer fluid-intake adherence. Confrontive coping was associated with poorer adherence for both high- and low-control situations.