Nazmiye KOCAMAN YILDIRIM, Ayşe OKANLI, ELANUR YILMAZ KARABULUTLU, Fadime KARAHİSAR, Sedat ÖZKAN

Hemodiyaliz hastalarının anksiyete ve depresyon belirtilerine hastalık algısının etkisi: Çok merkezli bir çalışma

Amaç: Bu çalışmanın amacı, hemodiyaliz tedavisi uygulanan son dönem böbrek yetmezliği hastalarında anksiye- te ve depresyon riskini saptamak ve Leventhalin modelini kullanarak anksiyete ve depresyon riski olan ve olma- yan hastaların hastalık algısını karşılaştırmaktır. Yöntem: Tanımlayıcı ve ilişki arayıcı tipteki bu kesitsel çalışma, üç üniversite hastanesinin Hemodiyaliz Ünitelerinde tedavilerini en az altı aydır sürdüren, 18 yaşından büyük, okuryazar, Türkçe iletişim kurabilen, zeka geriliği ve psikotik bozukluk gibi psikiyatrik bozukluğu olmayan, çalış- maya gönüllü olarak katılmayı kabul eden 124 hasta ile gerçekleştirildi. Veriler, yarı yapılandırılmış görüşme formu, Hastane Anksiyete ve Depresyon Ölçeği, Hastalık Algısı Ölçeği ile elde edildi. Hastalık algısı Leventhalin öz-düzenleme (self-regulation) modeline temellendirildi. Verilerin analizinde frekans dağılımı, t testi, ANOVA, Pearson korelasyon analizi ve ki-kare testi kullanıldı. Sonuçlar: Hastaların yaş ortalaması 50.7±14.5 (18-80) yıl olup, %55.6sı erkek, %33.9u ilkokul mezunu ve %69.4ü evli idi. Ortalama yedi yıldır hemodiyaliz tedavisine devam eden hastaların %22.6sı anksiyete, %49.2si depresyon açısından riskli bulundu. Anksiyete riski olan hastalarda hastalığı anlama puanının düşük ve emosyonel temsiller puanının yüksek olduğu saptandı. Depresyon riski olan hastalarda kişisel kontrol puanının düşük, süre (döngüsel) ve emosyonel temsiller puanının yüksek olduğu belirlendi. Tartışma: Hemodiyaliz hastalarının yarısı anksiyete veya depresyon açısından risk altındadır. Anksiyete veya depresyon riski olan hastaların hastalık algısının olumsuz olduğu görülmektedir. Öz-düzenleme modeline göre bilişsel ve emosyonel süreçler paralel işlediğinden, hemodiyaliz hastalarının hastalık hakkında negatif inançlarının anksiyete/depresyona etkisinin uzunlamasına çalışmalarda da test edilmesi önerilir.

Effects of illness perception on anxiety and depressive symptoms in hemodialysis patients: a multi-center study

ABSTRACT Objective: The aims of this study were to assess anxiety and depression risk in hemodialysis patients with end- stage renal failure, and to compare illness perception between patients with or without anxiety and depression risk, using Leventhals model. Methods: This cross-sectional study was conducted on 124 patients of three major university hospitals. Subjects were 18 years or older, undergoing treatment in a hemodialysis unit for at least 6 months, literate and could communicate in the Turkish language. Patients who were mentally retarded or had psychiatric conditions i.e. psychotic disorders were excluded from the study. Voluntary informed consent was sought from all subjects. Data were collected with a semi-structured questionnaire, Hospital Anxiety and Depres- sion Scale and Illness Perception Questionnaire-Revised (IPQ-R). Illness perception was grounded on Levent- hals self-regulation model. Data were analyzed using frequency distributions, Students t-test, ANOVA, Pearson correlation and chi-square tests. Results: The mean age of patients was 50.7±14.5 (18-80) years, 55.6% were male, 33.9% were literate and 69.4% were married. Our results showed that 22.6% of the subjects who under- went hemodialysis for an average of seven years were at risk for anxiety and 49.2% for depression. Patients with anxiety risk had lower IPQ-R dimensional scores in illness coherence and higher scores in emotional represent- tation, whereas those with depression risk had lower scores in personal control but higher scores in timeline (cyclical) and emotional representation. Conclusion: Hemodialysis patients are at high risk of anxiety and/or de- pression and this is valid for almost half of the current study sample. Our results show that patients with high risk of anxiety or depression had negative perception of illness. As the self-regulation model is based on a parallel processing of cognitive and emotional representations of illness, further studies in longitudinal design are re- commended to better assess the effect of negative illness perceptions on anxiety/depression in hemodialysis patients.

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