Revised dyadic adjustment scale as a reliable tool for assessment of quality of marital relationship in patients on long-term hemodialysis.

Although the revised dyadic adjustment scale (RDAS) has been widely used as an indicator of the quality of marital relationship, no report is available on the reliability of this measure in patients on hemodialysis. We examined the internal consistency of the RDAS in a group of Iranian patients undergoing maintenance hemodialysis. A translated Persian version of the RDAS was self-administered to 135 patients. The internal consistency of the RDAS was tested using the Chronbach alpha coefficient which was 0.898, 0.683, 0.779, 0.827, and 0.836 for the RDAS total score and the dyadic consensus, affective expression, dyadic satisfaction, and dyadic cohesion subdomains, respectively. All of the Chronbach alpha scores were higher in patients with higher income and education level. Using the RDAS to examine marital relationship quality in patients on hemodialysis, the total score and almost all subscores except for dyadic consensus had adequate internal consistency.

Marital adjustment in patients on long-term hemodialysis: a case-control study.

INTRODUCTION: This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients. MATERIALS AND METHODS: In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group. RESULTS: Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels. CONCLUSIONS: Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis.

Socioeconomic links to health-related quality of life, anxiety, and depression in kidney transplant recipients.

INTRODUCTION: The impact of socioeconomic status on the chance of being a candidate of kidney transplantation and its effect on graft survival has been documented. Our aim was to investigate the association of socioeconomic status with kidney allograft recipients' health-related quality of life and level of anxiety and depression. MATERIALS AND METHODS: Two hundred and forty-two kidney transplant recipients were categorized according to their monthly family income into low-income, moderate-income, and high-income groups. These groups were compared in terms of health-related quality of life (short form-36) and level of anxiety and depression symptoms (hospital anxiety depression scale). RESULTS: There was a trend of higher HRQOL scores in association with a higher income, which was significant for the total HRQOL score and its subdomains of physical function and role limitation due to physical and emotional problems. A slight increase in anxiety symptom scores was also seen in kidney recipients with lower incomes; however, the depression symptom scores were not significantly different between the income groups. Logistic regression analysis showed that the impact of income on the total HRQL and anxiety symptoms scores remained significant after controlling the effect of age, sex, and time interval from transplantation. CONCLUSIONS: A significant proportion of our kidney allograft recipients had a low income and had a poorer health-related quality of life and a greater load of anxiety according to their perception of their status, compared to those with higher incomes. Special consideration to kidney transplant recipients with a lower income may improve their wellbeing.

Marital relationship and its correlates in kidney recipients.

Marital discordance is known to be associated with morbidity and mortality in chronically ill patients, but its correlates have yet to be fully addressed in renal recipients. The aim of this study was to assess marital relationship and its correlation with patients' morbidity after kidney transplantation. Ninety-three married Iranian kidney recipients who had undergone kidney transplantation in Baqiyatallah Hospital, Tehran, Iran, were assessed for marital adjustment with the Revised Dyadic Adjustment Scale (RDAS). The patients' quality of life (Short From-36), anxiety and depression (Hospital Anxiety and Depression Scale), and sexual relationship (Relationship and Sexuality Scale) were also evaluated. Eighty-seven subjects (93.5%) completed our study. The mean (SD) of RDAS was 52.9 (9.7). RDAS score showed a significant correlation with anxiety symptoms, frequency of intercourse and quality of life (p < 0.05). Also, RDAS score was poorer in recipients with low education level, low family income and positive history of graft rejection (p < 0.05). RDAS score was not significantly associated with gender, occupation, age at transplantation time, transplant-to-rejection time interval, source of graft, cause and duration of end-stage renal disease and depression (p > 0.05). Transplantation medical teams should refer patients to psychologists and/or psychiatrists for marital satisfaction consultation before kidney transplantation. This is of great significance especially in those with older ages, lower levels of education and lower income. Marital discord may also be considered as a cause or an effect of an unsatisfactory sexual relationship, higher anxiety or lower quality of life after kidney transplantation.

Logistic regression models for predicting physical and mental health-related quality of life in rheumatoid arthritis patients.

The aim of this work was to develop two logistic regression models capable of predicting physical and mental health related quality of life (HRQOL) among rheumatoid arthritis (RA) patients. In this cross-sectional study which was conducted during 2006 in the outpatient rheumatology clinic of our university hospital, Short Form 36 (SF-36) was used for HRQOL measurements in 411 RA patients. A cutoff point to define poor versus good HRQOL was calculated using the first quartiles of SF-36 physical and mental component scores (33.4 and 36.8, respectively). Two distinct logistic regression models were used to derive predictive variables including demographic, clinical, and psychological factors. The sensitivity, specificity, and accuracy of each model were calculated. Poor physical HRQOL was positively associated with pain score, disease duration, monthly family income below 300 US$, comorbidity, patient global assessment of disease activity or PGA, and depression (odds ratios: 1.1; 1.004; 15.5; 1.1; 1.02; 2.08, respectively). The variables that entered into the poor mental HRQOL prediction model were monthly family income below 300 US$, comorbidity, PGA, and bodily pain (odds ratios: 6.7; 1.1; 1.01; 1.01, respectively). Optimal sensitivity and specificity were achieved at a cutoff point of 0.39 for the estimated probability of poor physical HRQOL and 0.18 for mental HRQOL. Sensitivity, specificity, and accuracy of the physical and mental models were 73.8, 87, 83.7% and 90.38, 70.36, 75.43%, respectively. The results show that the suggested models can be used to predict poor physical and mental HRQOL separately among RA patients using simple variables with acceptable accuracy. These models can be of use in the clinical decision-making of RA patients and to recognize patients with poor physical or mental HRQOL in advance, for better management.

Correlation between sexual function and postrenal transplant quality of life: does gender matter?

INTRODUCTION: Subjective health perceptions affect sexual function differently in males and females; such differences, however, have not hitherto been studied comprehensively in kidney-transplant recipients. AIM: This study sought to investigate gender effect on the correlation between sexual function and quality-of-life (QOL) subdomains in kidney-transplant recipients by evaluating intercourse frequency (IF) and intercourse satisfaction (IS). METHODS: In a cross-sectional study, 124 married kidney-transplant recipients, who were randomly selected, were interviewed. The bivariate correlations between QOL subdomains, and IF and IS were analyzed with the Pearson test in the males and females, separately. MAIN OUTCOME MEASURE: The IF and IS using the relationship and sexuality scale, and also the QOL using Short Form 36 (SF-36) were assessed. RESULTS: Sixty-seven subjects (54%) reported having no intercourse within the preceding months. Fifty subjects (40%) reported having no intercourse satisfaction. While IF and IS correlated with the total SF-36 score in the males (r = 0.252 and 0.263, P < 0.05), there was no such correlation in the females. In the males, IS correlated with physical health (r = 0.281, P < 0.05) and physical function (r = 0.274, P < 0.05), and there was a correlation between IF and role limitation due to emotional problems (r = 0.250, P < 0.05). In the females, whereas IF correlated with general health (r = 0.372, P < 0.05) and mental health (r = 0.305, P < 0.05), there was no correlation between IS and QOL subdomains (P > 0.05). CONCLUSION: Sexual function and satisfaction seem to be correlated with mental and physical health in female and male kidney-transplant recipients, respectively. Although in the two genders, both physical and mental health should be equally evaluated; improving of the sexual function may be better achieved through different approaches.