Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study

Abstract

BackgroundHemodialysis patients are exposed to disease- and treatment-related stresses, and use various coping strategies to deal with these stresses. Although some studies have reported the association of coping strategies with mortality or health-related quality of life (QOL) in some populations, the effect of coping strategies on clinical outcomes in hemodialysis patients remains unclear. We investigated the association in a longitudinal design among Japanese hemodialysis patients.MethodsWe examined Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) IV, which was conducted between 2009 and 2012. The exposure variable was stress coping strategy, as assessed using subscales in Coping Strategies Inventory Short Form: problem-focused engagement, problem-focused disengagement, emotion-focused engagement, and emotion-focused disengagement. Hazard ratios were estimated using Cox proportional hazard model for all-cause mortality and mean differences for change in health-related QOL in 1 year were estimated using a regression model.ResultsAmong 1,354 patients, only problem-focused engagement was significantly associated with longer survival; other subscales were not associated with all-cause mortality after adjustment for potential confounding factors. In terms of health-related QOL, the subscale of problem-focused engagement was also associated with improvement in physical functioning and mental health among 1,045 patients. Emotion-focused disengagement was associated with deterioration in mental health, but not with change in physical functioning. The other subscales were not associated with change in physical functioning or mental health.ConclusionsAmong hemodialysis patients, “problem-focused engagement” coping strategies were associated with longer survival and also with improvement in physical functioning and mental health. To achieve greater longevity and improve QOL in hemodialysis patients under ongoing stresses, problem-focused engagement should be encouraged.

Relationship Among Coping Strategies, Quality of Life, and Anxiety and Depressive Disorders in Hemodialysis Patients

“…Although both strategies bring about a reduction in stress, studies showed that those individuals who use emotion-focused coping strategies have lower psycho cognitive adaptation (41). Studies which investigated the relationship between coping strategies and quality of life in hemodialysis patients, emotion-focused coping showed a deteriorating effect on mental component of QOL in Japanese, Brazilian, and Iranian hemodialysis patients (15,42,43). In contrast with these studies, in this study emotion-focused coping strategies' total score was found to be lower in patients with depressive disorder and correlated with better QOL.…”

Relationship between stress coping strategies, psychological distress, and quality of life among hemodialysis patients

“…Research on diabetes patients showed that the ways in which adolescents with type 1 diabetes cope with diabetes‐related stress predict quality of life and symptoms of depression . Also, emotion‐focused coping showed a deteriorating effect on mental health of Japanese and Brazilian hemodialysis patients …”

Treatment-related stress and coping: an important consideration in patients on hemodialysis

“…There are many studies on the treatment-related stressors experienced and coping strategies used by patients on HD [2,[8][9][10][11][12]. In Tu et al [8]'s study, Taiwanese patients on HD aged 20-45 years were found to have high stress levels.…”

“…In Kara [2]'s study, higher treatmentrelated stress levels were also associated with lower coping strategies in Turkish patients on HD [2]. Interestingly, in the Japan Dialysis Outcomes and Practice Patterns Study of 1,354 patients on HD, it was found that "problem-focused engagement" as coping strategies were associated with both longer survival and improvement in physical functioning and mental health [12].…”

“…Consequently, the results of studies showed that patients on HD often experience high stress levels, and use both emotion-focused and problem-focused coping strategies [2,[8][9][10][11][12]. In this context, nurses play an integral role in providing care, symptom control, psychosocial support, stress management and advice for patients on HD and their family members.…”