title: Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study.
abstract: OBJECTIVE
  : Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression.
  
  
  METHODS
  : We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil.
  
  
  METHODS
  :Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale.
  
  
  RESULTS
  : The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053).
  
  
  CONCLUSIONS
  :Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.
authors.affiliation: MSc. Attending Psychologist, Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, and Research Fellow, Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Daniela Cristina Sampaio de
authors.initials: DC
authors.lastname: Brito
authors.affiliation: MSc. Assistant Professor of Nursing, Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, and Research Fellow, Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Elisa Oliveira
authors.initials: EO
authors.lastname: Marsicano
authors.affiliation: PhD. Adjunct Professor of Psychology, Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, and Research Fellow, Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Fabiane Rossi Dos Santos
authors.initials: FR
authors.lastname: Grincenkov
authors.affiliation: MD, PhD. Adjunct Professor of Medicine, Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, and Research Fellow, Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Fernando Antônio Basile
authors.initials: FA
authors.lastname: Colugnati
authors.affiliation: MD, PhD. Adjunct Professor of Medicine, Department of Medicine, Núcleo de Pesquisas em Espiritualidade e Saúde (NUPES), Federal University of Juiz de Fora, Brazil.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Lucchetti
authors.affiliation: MD, PhD. Associate Professor of Medicine, Head of Renal Transplantation Unit, Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, and Research Fellow, Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil.
authors.forename: Helady
authors.initials: H
authors.lastname: Sanders-Pinheiro
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000067290:Behavior Rating Scale; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D057566:Self Report; D018709:Statistics, Nonparametric; D013315:Stress, Psychological; D016312:Treatment Refusal / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents