Dyadic relationship conflict, gender, and mortality in urban hemodialysis patients.
The effects of dyadic satisfaction and conflict have not been well defined in the hemodialysis (HD) population. The aim of this study was to determine whether the perception of decreased dyadic satisfaction was associated with mortality in patients treated with HD, and if so, whether there were different relationships between risk factors, and differential outcomes in men and women. A total of 174 HD patients, primarily African-Americans, involved in dyadic relationships for more than 6 mo had indices of dyadic satisfaction, depression, perception of illness effects, social support, behavioral compliance with the dialysis prescription, and plasma interleukin-1 (IL-1) and beta-endorphin levels measured. Cox proportional hazards models assessed relative mortality risks. Patients' dyadic satisfaction scores correlated with beta-endorphin levels. There was no correlation of IL-1 or beta-endorphin with any psychosocial or behavioral compliance measure in the group as a whole. Correlations between psychosocial, medical, and neuroimmunologic variables were different in men and women. For women, dyadic satisfaction correlated with beta-endorphin levels, depression, and perception of illness. Women with higher dyadic satisfaction and decreased dyadic conflict were at decreased mortality risk, but dyadic adjustment indices were unassociated with differential survival in the larger group of men. Correlations between neuroendocrine and immune markers are different in African-American male and female HD patients. Greater dyadic satisfaction and lower dyadic conflict are independently associated with decreased mortality in female African-American HD patients, of the same order of magnitude as medical risk factors. Such effects may be attributable to a relationship between dyadic satisfaction and conflict and health-related behaviors, or through an effect on neuroendocrine or immunologic status.
Kimmel
Paul L
PL
Department of Medicine, George Washington University Medical Center, Washington, D.C.
Peterson
Rolf A
RA
Department of Psychology, George Washington University, Washington, D.C.
Weihs
Karen L
KL
Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, Washington, D.C.
Shidler
Nicole
N
Department of Psychology, George Washington University, Washington, D.C.
Simmens
Samuel J
SJ
School of Public Health, George Washington University Medical Center, Washington, D.C.
Alleyne
Sylvan
S
Department of Human Development and Psychoeducational Studies, Howard University Medical Center, Washington, D.C.
Cruz
Illuminado
I
Department of Medicine, Howard University Medical Center, Washington, D.C.
Yanovski
Jack A
JA
Section on Women's Health, Developmental Endocrinology Branch, National Institute of Child Health and Development, National Institutes of Health, Bethesda Maryland.
Veis
Judith H
JH
Department of Medicine, Washington Hospital Center, Washington, D.C.
Phillips
Terry M
TM
Department of Medicine, George Washington University Medical Center, Washington, D.C.
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003220:Conflict, Psychological; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D018454:Spouses; D014505:Urban Population; D001615:beta-Endorphin / Q000097:blood
D001615:beta-Endorphin