Journals | Policy | Permission

World Journal of Nephrology & Urology

Original Article

Volume 1, Number 4-5, October 2012, pages 101-106

The Impact of Sociodemographic and Psychological Variables on Quality of Life in Patients With Renal Disease: Findings of a Cross-Sectional Study in Greece

Renal failure is a chronic disease that can have serious effects on many patients’ quality of life (QoL) and specifically on their social, financial and psychological well-being [1-4]. End-stage renal disease (ESRD) patients in different treatment modalities have been reported to experience serious deficits of QoL [5-9]. In particular, patients with several years in heamodyalis (HD) treatment modality, compared to patients in peritoneal dialysis (PD) treatment, were found to experience poorer QoL regarding physical health, social relationships and environment [10-12]. The burden of the disease on the patient and the family is high, corresponding to an increased research interest in QoL issues for these patients in the context of different treatment modalities [13].

Regarding the effect of sociodemographic variables on patients’ QoL and mental health, gender is reported to have an effect; so female patients present higher scores of depression and trait anxiety and lower scores in positive affect [14-17]. Male patients are reported of having more social activities and interests and better QoL [14, 18, 19].

Further, older patients present lower levels of physical well-being and higher scores of depression [17, 20-27]. Regarding the effect of socioeconomic status, patients in the lower range face many problems, including poorer mental and general health and lower social well-being [28, 29], whereas higher economic and educational level is associated with higher health-related QoL [18, 30]. Concerning marital status, being married is related to better physical well-being [24].

The present study might contribute to the existing body of knowledge indicating the influence of sociodemographic and clinical characteristics on patients’ QoL as well as the significant interventions which can be developed by the health professionals in order to support end-stage renal disease patients. The objective of this study was to investigate the relationship of QoL to sociodemographic variables (gender, age, education, marital status) as well as clinical variables (self-reported mental health, depression and anxiety) in end-stage renal disease patients (ESRD). For this purpose, measures assessing QoL as well as mental health were used.

A sample of 144 patients was recruited from a General Hospital in the broader area of Athens, consisting of 84 patients (58.3%) undergoing in-centre haemodialysis (HD) and 60 patients (41.7%) in continuous ambulatory peritoneal dialysis (PD). Differences of QoL between these two groups of patients have been investigated and reported (4). Selection criteria included: 1) > 18 years of age; 2) Ability of communication in Greek; 3) Diagnosed with end-stage renal disease; 4) Dialysis treatment at least for a year; 5) Satisfying level of cooperation and perceived ability.

The rate of response was very high, reaching 99%. Thus, the total sample includes almost all patients of these three units, consisting of 86 males (59.7%) and 58 females (40.3%), with a mean age of 60.6 years ± 14.9. Participants were Greek adults having signed a consent form for participation. All subjects had been informed of their rights to refuse or discontinue participation in the study according to the ethical standards of the Helsinki Declaration. Ethical permission for the study was obtained from the scientific committees of the participating hospitals. Full descriptive data of the sample are presented in Table 1.

Click to view

Table 1. Sociodemographic Characteristics of the Sample (N = 144)

WHOQOL-BREF is a self-report 26-item QoL inventory developed by the World Health Organization [31]. The items comprise a 4-domain model: a) physical health; b) psychological health; c) social relationships and d) environment. Also, a facet of two items is included referring to overall QoL/health. The Greek version is a 30-item form with 4 new national items referring to: 1) nutrition; 2) satisfaction with work; 3) home life and 4) social life [32]. Higher scores indicate a better QoL. The Greek version of WHOQOL-BREF provided satisfactory psychometric properties supporting its use within general and pathological populations and in the context of national and crosscultural QoL measurement.

General Health Questionnaire (GHQ-28) version is a widely used self-report measure designed to detect psychiatric problems in general settings [33], which has been standardized in Greek populations [34]. It includes four sub-scales: a) somatic symptoms; b) anxiety/insomnia; c) social dysfunction and d) severe depression. Higher scores indicate a worse general condition of health. All the validity indices of GHQ-28 (sensitivity, specificity, positive predictive value, negative predictive value and overall misclassification rate) were quite satisfactory, thus confirming the validity of the questionnaire in its Greek version [34].

Trait Anxiety Inνentory (STAI 2), and it consists of 20 items referring to self-reported trait anxiety [35]. The instrument is standardized in Greek populations [36]. Higher scores indicate the presence of state and trait anxiety.

Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item self-report measure of depression [37, 38]. According to Fountoulakis et al., it is suggested that for Greek populations a value above 9.03 is indicative that a subject can be classified as depressed [39].

The Greek translation of the CES-D scale as well as the STAI inventory is both reliable and valid and is suitable for clinical and research use with satisfactory properties.

The values of the two gender groups were found to pass the normality distribution, with the use of Kolmogorov-Smirnov Z test. The effects of sociodemographic variables on the patients’ QoL were examined through a regression analysis model. Gender, age, education and marital status were introduced in the model as independent variables and the WHOQOL domains and overall QoL as dependent. The variable of marital status, in order to be included in the analyses, was recoded in three categories, that is single, married and divorced/widowed.

Age was found to have an effect on QoL’s physical and social domains, gender on psychological domain, while education on the domain of environment. Marital status was observed to have a relationship with the psychological and social domains (Table 2).

Click to view

Table 2. Hierarchical Regression Analysis: Sociodemographic and Clinical Variables Affecting Quality of Life (QoL) Domains and Overall QoL/Health

Further regression analyses were conducted investigating the possible relationship of mental health variables with QoL, thus introducing in the model the participation of depression, trait-anxiety and total GHQ-28 score as independent variables (Table 2). Results indicated that depression had an effect on all QoL domains and on the overall QoL/health facet. Trait anxiety was observed to affect the psychological health and environment domains. The GHQ-28 total score affected the domains of physical health and environment.

Investigating the effect of sociodemographic and mental health variables on QoL, the results suggest that there are significant relations of these variables to QoL. Age seems to affect the patients’ physical health and social relations domains, bringing into focus the negative effect of older age in important aspects of these patients’ quality of life.

These findings are in agreement with several studies indicating that older patients present lower levels of physical well-being and higher levels of depression [17, 20-27].

Gender seems to have a relation to the psychological domain, suggesting that psychological health, which is considered a major component, could represent QoL. Positive feelings, that were reported to be the best predictor in overall QoL [40], may be affected by gender differences, making female patients with end-stage renal disease more vulnerable to QoL deficits.

This finding is in agreement with several studies on chronic diseases, presenting female patients feeling more depressed than males [14-17], with a higher prevalence of trait anxiety [14, 16] and being more socially restricted, while their everyday life and level of functioning were negatively affected [29, 41].

Education appears to have an effect on the environment domain, suggesting that more educated patients hold more positive perceptions about their environment. It seems that they may have an advantage in monitoring adequately different aspects of their external world leading thus to a more favourable evaluation of it. Also, this may be interpreted that more educated patients seem better equipped to create for themselves a more satisfactory environment, with better health services, finances, recreation and other related aspects. In overall, patients with lower socioeconomic profiles or lacking in education (which is generally taken as an indicator of social status), are reported in the literature facing problems in their psychological well-being, social relationships and general health [18, 28-30].

As for marital status, it seems that it affects the psychological and social domains of QoL, suggesting that better psychological and social well-being can be associated with family conditions and living with a partner. On the basis of these findings, married patients seem to experience a better QoL. Similar evidence in the literature indicates that the status of marriage in these patients may be significantly correlated with an enhanced physical well-being [24].

These results provide useful indications that certain variables referring to the patient’s sociodemographic profile may affect favourably or unfavourably his/her QoL. In the present study, being male, younger, more educated and married appeared to have a favourable effect on several aspects of the patients’ QoL. The findings are in agreement with evidence in the literature indicating that sociodemographic factors may to some extent contribute to the explanation of overall QoL [42]. According to Sprangers et al [43], independent of the kind of illness, being female, older, less educated and living without a partner are connected with a lower QoL.

In overall, our findings provide evidence which can be useful to health professionals and managers of health services offered to end-stage renal disease patients. Tailored interventions can be developed to support female but also male patients, those who are older, less educated, living alone, depressed, anxious, in an effort to address issues of compromised QoL. Psychological and psychoeducational interventions, as well as health promotion educational programmes, may be considered for renal patients bringing into focus specific aspects of their negatively perceived mental health, like being depressed, or having suicidal ideation.

Regarding limitations in the study, it is noted that patients were recruited from three renal units and were a convenience sample. Thus, it was not possible to have an adequate control on demographic or clinical variables. Evidence provided by the results of this study can be further extended by the control of the above variables and the use of even larger samples. Also, limitations of the study may include the lack of investigating the effect of clinical factors such as duration and adequacy of dialysis, hemoglobin level or other clinical parameters (comorbid conditions such as diabetes or cardiovascular disorder) on the patients’ perceptions of quality of life.

Acknowledgments

The author would like to thank the patients for their cooperation and interest in the study. She would like also to recognise the support of health professionals and administration personnel of the dialysis units that participated in the study. Further, the author confirms that there were no grants and funds in support of this study and there is no conflict of interest.

1. Ginieri-Coccossis M, Theofilou P, Synodinou C, Tomaras V, Soldatos C. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: investigating differences in early and later years of current treatment. BMC Nephrol. 2008;9:14.
   doi pubmed
2. Theofilou PA. Sexual functioning in chronic kidney disease: the association with depression and anxiety. Hemodial Int. 2012;16(1):76-81.
   pubmed
3. Theofilou P. Depression and anxiety in patients with chronic renal failure: the effect of sociodemographic characteristics. Int J Nephrol. 2011;2011:514070.
4. Theofilou P. Quality of life in patients undergoing hemodialysis or peritoneal dialysis treatment. J Clin Med Res. 2011;3(3):132-138.
   pubmed
5. Theofilou P. Quality of life and mental health in hemodialysis and peritoneal dialysis patients: the role of health beliefs. Int Urol Nephrol. 2012;44(1):245-253.
   doi pubmed
6. Theofilou P. Non - compliance with medical regimen in haemodialysis treatment: a case study. Case Reports in Nephrology, 2011;2011:476038.
   doi
7. Theofilou P. Association of insomnia symptoms with kidney disease quality of life reported by patients on maintenance dialysis. Psychol Health Med. 2013;18(1):70-78.
   doi
8. Theofilou P. Self - reported functional status: an important predictor of mental health outcomes among chronic dialysis patients. European Journal of Psychological Assessment. (in press).
9. Theofilou P. Undergoing haemodialysis - A qualitative study to investigate the lived experiences of patients. Europe's Journal of Psychology. (in press).
10. Theofilou P. Self-esteem in Greek dialysis patients: the contribution of health locus of control. Iran J Kidney Dis. 2012;6(2):136-140.
    pubmed
11. Theofilou P. The relation of social support to mental health and locus of control in Chronic Kidney Disease. Journal of Renal Nursing. 2012;4;18-22.
12. Theofilou P. Medication Adherence in Greek Hemodialysis Patients: The Contribution of Depression and Health Cognitions. Int J Behav Med. 2012.
    doi
13. Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Boyle DH, Cruz I, Umana WO, et al. Aspects of quality of life in hemodialysis patients. J Am Soc Nephrol. 1995;6(5):1418-1426.
    pubmed
14. Vazquez I, Valderrabano F, Fort I, Jofre R, Lopez-Gomez JM, Moreno F, Sanz-Guajardo D. [Differences in health-related quality of life between male and female hemodialysis patients]. Nefrologia. 2004;24(2):167-178.
    pubmed
15. Gottlieb SS, Khatta M, Friedmann E, Einbinder L, Katzen S, Baker B, Marshall J, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients. J Am Coll Cardiol. 2004;43(9):1542-1549.
    doi pubmed
16. Di Marco F, Verga M, Reggente M, Maria Casanova F, Santus P, Blasi F, Allegra L, et al. Anxiety and depression in COPD patients: The roles of gender and disease severity. Respir Med. 2006;100(10):1767-1774.
    doi pubmed
17. Oikonomidou G, Zlatanos D, Vayopoulos H, Hatzidimitriou H. Depression in patients with chronic renal failure. Dialysis Living 2005; 14: 22-32 (in Greek).
18. Rebollo P, Ortega F, Baltar JM, Diaz-Corte C, Navascues RA, Naves M, Urena A, et al. Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years. Geriatr Nephrol Urol. 1998;8(2):85-94.
    doi pubmed
19. Gil Cunqueiro JM, Garcia Cortes MJ, Foronda J, Borrego JF, Sanchez Perales MC, Perez del Barrio P, Borrego J, et al. [Health-related quality of life in elderly patients in haemodialysis]. Nefrologia. 2003;23(6):528-537.
    pubmed
20. Kutner NG, Jassal SV. Quality of life and rehabilitation of elderly dialysis patients. Semin Dial. 2002;15(2):107-112.
    doi pubmed
21. Dimkovic N, Oreopoulos DG. Chronic peritoneal dialysis in the elderly. Semin Dial. 2002;15(2):94-97.
    doi pubmed
22. Apostolou T, Gokal R. Quality of life after peritoneal dialysis. In: Gokal R, Khanna RTh, Krediet R, Nolph KD (ed). Textbook of Peritoneal Dialysis, The Netherlands: Kluwer Academic Publishers, 2000; 709-735.
23. Iacovides A, Fountoulakis KN, Balaskas E, Manika A, Markopoulou M, Kaprinis G, Tourkantonis A. Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis. Aging Clin Exp Res. 2002;14(5):354-360.
    pubmed
24. Chiang CK, Peng YS, Chiang SS, Yang CS, He YH, Hung KY, Wu KD, et al. Health-related quality of life of hemodialysis patients in Taiwan: a multicenter study. Blood Purif. 2004;22(6):490-498.
    doi pubmed
25. Vasilieva IA. Quality of life in chronic hemodialysis patients in Russia. Hemodial Int. 2006;10(3):274-278.
    doi pubmed
26. Tyrrell J, Paturel L, Cadec B, Capezzali E, Poussin G. Older patients undergoing dialysis treatment: cognitive functioning, depressive mood and health-related quality of life. Aging Ment Health. 2005;9(4):374-379.
    doi pubmed
27. Moshopoulou E, Savidaki E. Psychosocial profile of haemodialysis patients. Approach - Intervention. Dialysis Living 2003; 7: 1-5 (in Greek).
28. Sesso R, Rodrigues-Neto JF, Ferraz MB. Impact of socioeconomic status on the quality of life of ESRD patients. Am J Kidney Dis. 2003;41(1):186-195.
    doi pubmed
29. Ellinikou M, Zissi A. Quality of life and chronic illnesses. Prognostic variables for the psychosocial rehabilitation of the patients with chronic illness. Medicine 2002; 82: 124-131 (in Greek).
30. Vazquez I, Valderrabano F, Jofre R, Fort J, Lopez-Gomez JM, Moreno F, Sanz-Guajardo D. Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. J Nephrol. 2003;16(6):886-894.
    pubmed
31. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299-310.
    doi pubmed
32. Ginieri-Coccossis M, Triantafillou E, Antonopoulou V, Tomaras V, Christodoulou GN (eds). Quality of Life Handbook in reference to WHOQOL-100. Athens: Medical Publications ΒΗΤΑ, 2003 (in Greek).
33. Goldberg DΡ (eds). Manual of the General Health Questionnaire. Windsor: NFER-Nelson, 1978.
34. Garyfallos G, Karastergiou A, Adamopoulou A, Moutzoukis C, Alagiozidou E, Mala D, Garyfallos A. Greek version of the General Health Questionnaire: accuracy of translation and validity. Acta Psychiatr Scand. 1991;84(4):371-378.
    doi pubmed
35. Spielberger GΟ (eds). The State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, 1970.
36. Liakos A, Giannitsi S. Reliability and Validity of the Greek State-Trait Anxiety Inventory of Spielberger. Encephalos 1984; 21: 71-76 (in Greek).
37. Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1: 385-401.
    doi
38. Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). J Psychosom Res. 1999;46(5):437-443.
    doi
39. Fountoulakis K, Iacovides A, Kleanthous S, Samolis S, Kaprinis SG, Sitzoglou K, St Kaprinis G, et al. Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) Scale. BMC Psychiatry. 2001;1:3.
    doi pubmed
40. Skevington SM. Measuring quality of life in Britain: introducing the WHOQOL-100. J Psychosom Res. 1999;47(5):449-459.
    doi
41. Dangoor N, Florian V. Women with chronic physical disabilities: correlates of their long-term psychosocial adaptation. Int J Rehabil Res. 1994;17(2):159-168.
    doi
42. Arnold R, Ranchor AV, Sanderman R, Kempen GI, Ormel J, Suurmeijer TP. The relative contribution of domains of quality of life to overall quality of life for different chronic diseases. Qual Life Res. 2004;13(5):883-896.
    doi pubmed
43. Sprangers MA, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB, Foets M, et al. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol. 2000;53(9):895-907.
    doi

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

World Journal of Nephrology and Urology is published by Elmer Press Inc.