The Impact of Depressive Affect and Coping Style on Medication Adhereance In An ESRD Population

Abstract

Background: End Stage Renal Disease (ESRD), a taxing and chronic medical condition that has increasing numbers in the United States, is associated with high levels of depression (Cukor, 2007). There is a well established relationship between depression and mortality in hemodialysis populations (Kimmel, 2000). A postulated mechanism for this relationship is through adherence to the dialysis prescription (Cukor, 2007). Non-adherence to the medication regimen has been associated with poorer health outcomes in this population (Kaveh & Kimmel, 2001). There may also be individual differences that impact this relationship, as an ineffective coping style has been shown to have an effect on one's health (Lazarus, 1993). The overall aim of this study is to examine the unique roles of depression and coping style on medication adherence in ESRD patients.;Methods: 85 participants from the hemodialysis center at SUNY Downstate Medical Center completed the study. Participants were assessed for adherence using the Immunosuppressive Therapy Adherence Scale-Modified (ITAS-M). Participants also completed the Brief COPE (BCOPE), and the Beck Depression Inventory (BDI).;Results: Hierarchical multiple regression analyses were used to examine predictors of medication adherence while controlling for demographic variables. Demographic variables were placed in the first step of the regression model. The first step of the model was significant (F=5.41, p< .01) and accounted for approximately 18% of the variance in medication adherence. Specifically, gender (beta = .242, p< .05) and age (beta = .274, p< .05) emerged as significant predictors of adherence. In the second step, the BDI was a significant predictor (beta=-.48, p<.001) and accounted for an additional 22% of the variance in the ITAS-M total score (F=12.39, P< .001). Coping was placed in the third step and was a statistically significant predictor of medication adherence and accounted for an additional 15% of the variance (F=12.38, p< .001). Problem-focused coping (beta=.44, p<.001) and emotion-focused coping (beta= -.41, p.05) was not found to be a significant predictor of adherence.;Discussion: The data suggest that while controlling for demographic variables, depression and coping style have unique contributions in explaining variance in adherence in this hemodialysis population. It appears that problem focused coping lends itself to better adherence, whereas greater amounts of emotion focused coping is associated with poorer adherence to prescribed medications. There are strong implications for intervention, as future research should explore the impact of treating depression as well as addressing positive coping strategies to improve medication adherence in ESRD population.