Aurélie Untas

The Associations of Social Support and Other Psychosocial Factors with Mortality and Quality of Life in the Dialysis Outcomes and Practice Patterns Study

BACKGROUND AND OBJECTIVES This study aimed to investigate the influence of social support and other psychosocial factors on mortality, adherence to medical care recommendations, and physical quality of life among hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data on 32,332 hemodialysis patients enrolled in the Dialysis Outcomes and Practice Patterns Study (1996 to 2008) in 12 countries were analyzed. Social support and other psychosocial factors related to ESRD and its treatment were measured by patient self-reports of health interference with social activities, isolation, feeling like a burden, and support from family and dialysis staff. Cox regression and logistic regression were used to examine associations of baseline social support and other psychosocial factors with all-cause mortality and with other measured outcomes at baseline, adjusting for potential confounders. RESULTS Mortality was higher among patients reporting that their health interfered with social activities, were isolated, felt like a burden, and were dissatisfied with family support. Poorer family support and several psychosocial measures also were associated with lower adherence to the prescribed hemodialysis length and the recommended weight gain between sessions. Some international differences were observed. Poorer self-reported social support and other psychosocial factors were associated with poor physical quality of life. CONCLUSIONS Poorer social support and other psychosocial factors are associated with higher mortality risk, lower adherence to medical care, and poorer physical quality of life in hemodialysis patients. More research is needed to assess whether interventions to improve social support and other psychosocial factors will lengthen survival and enhance quality of life.

Assessment and effects of Therapeutic Patient Education for patients in hemodialysis: A systematic review

OBJECTIVE This review examined the impact of Therapeutic Patient Education (TPE) programs in hemodialysis and the assessment of these programs. REVIEW METHODS AND DATA SOURCES: A systematic review was performed. Bibliographical research was done with a database in the social and human sciences (PsychINFO, PsycARTICLES, SocINDEX with Full Text and the Psychology and Behavioural Sciences Collection). References were also searched in several reviews specialized in nephrology-dialysis and in patient education. Articles were classified according three different outcomes: (1) physiological outcomes, (2) psychosocial outcomes, (3) or combined criteria. RESULTS 35 articles were selected. The majority dealt with purely physiological outcomes (18) and the minority concerned only psychosocial outcomes (4). Fifteen articles discussed both physiological and psychosocial outcomes, i.e. combined criteria. Beneficial effects were shown such as improvements in knowledge, adherence and quality of life. Most educational interventions were performed by nurses. CONCLUSION This systematic review found that educational programs in dialysis have become more numerous and efficient, with a prevalence of assessment based on physiological outcomes. TPE is a global management method based on both the physiological and the psychological well-being of the patient. Studies that take into account both physiological and psychosocial variables are very useful for understanding the effects of TPE programs on dialysis patients. The review shows that nurses play an important role in TPE and that they require varied communicational, educational, animation and assessment skills. These positive effects are encouraging for nurses to stimulate the development of TPE programs for dialysis patients in their multidisciplinary teams. The nurses role is important for the commitment of each health caregiver (nurse, physician, dietician, pharmacist, psychologist, etc.) for the global management of patients in the TPE process.

Anxiété et dépression en hémodialyse : validation de l’Hospital Anxiety and Depression Scale (HADS)

Anxiety and depression are considered as frequent disorders in end-stage renal disease patients. However studies on this topic are almost nonexistent in France. The Hospital Anxiety and Depression Scale (HADS, Zigmond & Snaith, 1983) is a well-used instrument in the international literature. Fast and easy to administer, it measures anxiety and depression symptomatology in physically ill patients. The purpose of the present study was to test the psychometric properties of the scale within a French sample of 207 hemodialysis patients. Exploratory factor analysis yielded two factors: anxiety and depression. Further analysis showed that the two factors presented good internal consistency, were significantly correlated to patients age and quality of life, but were not associated with years on dialysis. Moreover, differences were found for gender and dialysis modality (self-care units versus in center). The results of this study underline the relevance of using the HADS to identify anxiety and depression and confirm the importance to take into account these disorders to enhance patients quality of life and global care.

Psychometric Properties of the French Adaptation of the Multidimensional Body Self Relations Questionnaire–Appearance Scales

The present study investigated the psychometric properties of the French adaptation of the Multidimensional Body Self Relations Questionnaire–Appearance Scales, a widely used instrument in body image research. The questionnaire is composed of five subscales: Appearance Orientation, Appearance Evaluation, Overweight Preoccupation, Self-classified Weight, and the Body Areas Satisfaction Scale. Exploratory factor analyses were conducted on a sample of 765 subjects for the first two subscales. As expected, the analyses yielded two factors: Appearance Orientation and Appearance Evaluation. Internal consistencies ranged between .66 and .88 and test-retest reliabilities ranged between .78 and .85 for the five subscales. Appearance evaluation and the Body Areas Satisfaction Scale showed good convergent validity with the Body Image Questionnaire. Validity was supported by comparing scores for sex, for groups according to body mass index (underweight, normal weight, overweight, and obese), and by exploring the influence of social desirability.

Family relations, mental health and adherence to nutritional guidelines in patients facing dialysis initiation

This study investigated the effect of family relations on patients’ adjustment to dialysis. The two main aims were to develop a family typology, and to explore the influence of family profile on the patients anxiety, depression and adherence to nutritional guidelines. The sample consisted of 120 patients (mean age 63 years; 67.5% of men). They completed several measures 1, 6 and 12 months after dialysis initiation. The scales used were the Family Relationship Index and the Hospital Anxiety and Depression Scale. Perceived adherence to nutritional guidelines was assessed using two visual analogical scales. Results showed that family relations remained stable over time. Cluster analysis yielded three family profiles, which were named conflict, communicative and supportive families. Patients belonging to conflict families perceived themselves as less adhering to nutritional guidelines. For these patients, anxiety and depressive moods increased significantly over time, whereas mental health remained stable over time for communicative and supportive families. This research underlines that family relations are essential in global consideration of the care of patients treated by dialysis. Conflict families seem especially at risk. They should be identified early to help them adapt to this stressful treatment.

The Effects of Hypnosis on Anxiety, Depression, Fatigue, and Sleepiness in People Undergoing Hemodialysis: A Clinical Report

Abstract This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8. Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically. Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased.

Quality of life and illness perception in primary biliary cirrhosis: a controlled cross-sectional study.

OBJECTIVE The aim of this study was to understand better the quality of life (QOL) and illness perception in women with primary biliary cirrhosis (PBC) through a comparison with women having diabetes. METHODS One hundred and ninety-four women took part in this study: 130 with PBC, 64 with type 2 diabetes. They were administered the SF-12 to measure QOL and the Brief Illness Perception Questionnaire to assess representations of their illness. Analysis of covariance with bootstrapping was used to compare QOL and illness perception scores by controlling age and mean disease duration. RESULTS Physical QOL was significantly worse for women with PBC than for women with diabetes. Women with PBC felt their disease would last longer and reported more symptoms and concerns related to their disease than women with diabetes. Significant differences were also observed for causes: women with PBC mainly reported autoimmune, emotional, unknown/unlucky and medical causes whereas women with diabetes reported mostly lifestyle and hereditary causes. Marginally significant differences were observed regarding consequences on daily life, feeling of control over the disease and emotional responses, which were shown to be worse in PBC. Mental QOL, treatment control and overall understanding of the disease was similar in both groups. CONCLUSIONS This study shows that women with PBC have a worse QOL and somewhat different illness perception than women with diabetes. Further research could help understand PBC specificities better in order to improve patient care, especially if factors such as fatigue or rarity of the disease explain these results.

Qualités psychométriques de l’adaptation française du Family Relationship Index (FRI)

OBJECTIVE The aim of the present study was to investigate the psychometric properties of the French adaptation of the Family Relationship Index (FRI) from Moos and Moos. The FRI is a self-report inventory which consists of 27 items assessing family relations. It is composed of three dimensions: family cohesion, family expressiveness (of feelings and emotions) and family conflict. METHOD The FRI was translated and adapted into French according to published recommendations. After appropriate cultural adaptations, the scale was administered to a sample of 976 students with a mean age of 21.9 years and 43.5% of men. The participants completed the FRI and three other questionnaires: the Family Adaptability and Cohesion Scale (FACES), the Satisfaction with Life Scale and the General Health Questionnaire. Confirmatory factor analyses were used to test different models with one and three factors. The psychometric properties of the short version of the FRI, proposed by Kissane and Bloch (2002) and composed of 12 items, were also studied. RESULTS Confirmatory factor analyses showed that the three factors solution was more relevant that the one factor solution (for Khi(2)/ddl, Root mean square error of approximation [RMSEA], Root mean square residual [RMR], Goodness of fit index [GFI], Adjusted goodness of fit [AGFI] and Comparative fit index [CFI]). However, three items belonging to family expression explained a small variance. Therefore, a version consisting of 24 items seemed more appropriate than the 27 items version proposed by Moos and Moos. Cultural differences may explain these results. Internal consistency was satisfactory for cohesion (0.79) and conflict (0.71) but weak for expression (0.55 for 27 items version and 0.62 for 24 items version). One month test-retest reliability showed high correlations for the three dimensions (from 0.77 to 0.85). Correlation between the cohesion subscale of the FRI and the cohesion subscale of the FACES was high (0.77), showing a good convergent validity. The correlations between the three FRI dimensions and the Satisfaction with Life Scale and the General Health Questionnaire were quite low (from -0.31 to 0.41). High family cohesion and high family expression were associated with high life satisfaction and good mental health. Conversely, high family conflict was associated with low life satisfaction and weak mental health. These results support the criterion validity of the FRI. Concerning the 12 items version of the FRI, the factor analysis results showed very good psychometric qualities. However, this short version had lower internal consistency (which ranged between 0.50 and 0.71), test-retest reliability (which ranged 0.68 and 0.81), convergent (0.69 for cohesion) and criterion validity (from -0.21 to 0.37 for the Satisfaction with Life Scale and from -0.28 to 0.19 for the General Health Questionnaire) than the longer versions. CONCLUSION The results of the present study show that the FRIs 24 items version seems to be the more relevant. Nevertheless, the 12 items version shows interesting qualities. Further studies should confirm these results on other samples. Given the lack of French-language surveys assessing family relations, the FRI will be a useful tool for research and clinical practice.

Dyadic Cross-Sectional Associations Between Depressive Mood, Relationship Satisfaction, and Common Dyadic Coping

ABSTRACT The aim of this cross-sectional study was to investigate the mediational role of common dyadic coping in the links between depressive mood and relationship satisfaction. We estimated two competing Actor–Partner Mediator Models, in which the dyad is the highest unit of analysis. The first model specified dyadic coping as a mediator in the association between relationship satisfaction and depression, whereas the second model specified dyadic coping as a mediator between depression and relationship satisfaction. Analyzing data from 198 couples, our findings provided a plausible approximation of the second model, representing the interactional model of depression. They showed that common dyadic coping mediates the link between depression and relationship satisfaction for men only.

Is Alexithymia Associated With Dyadic Coping in Couples

The aim of this study was to explore associations between alexithymia and dyadic coping in couples. The Toronto Alexithymia Scale and the Dyadic Coping Inventory were administered to 112 heterosexual couples. The results showed that higher alexithymia was associated with lower dyadic coping for each partner. Unexpectedly, these associations were reversed regarding the couples alexithymia: higher alexithymia in the couple was associated with higher dyadic coping. Associations differed by gender. This study provides a better understanding of the effect of alexithymia on the way couples face stress and underlines the need to investigate alexithymia in couple research and practice.