title: Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study.
abstract: BACKGROUND
  Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables.
  
  
  METHODS
  The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style.
  
  
  RESULTS
  Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant.
  
  
  CONCLUSIONS
  The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.
authors.affiliation: Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina 45110, Greece. akalts@cc.uoi.gr
authors.forename: Anna
authors.initials: A
authors.lastname: Kaltsouda
authors.forename: Petros
authors.initials: P
authors.lastname: Skapinakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Damigos
authors.forename: Margarita
authors.initials: M
authors.lastname: Ikonomou
authors.forename: Rigas
authors.initials: R
authors.lastname: Kalaitzidis
authors.forename: Venetsanos
authors.initials: V
authors.lastname: Mavreas
authors.forename: Kostas C
authors.initials: KC
authors.lastname: Siamopoulos
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D003674:Defense Mechanisms; D005260:Female; D006306:Health Surveys / Q000379:methods; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D055815:Young Adult