Abstract
Waiting for an organ transplant is a stressful experience frequently associated with symptoms of depression and anxiety. Little empirical work has examined patients during the stressful period prior to transplantation, particularly among patients waiting for a renal transplant. A large body of research has demonstrated that social and family support variables are associated with psychological adjustment in a variety of medical populations. Little research has examined the mechanism by which social support exerts its effects on psychological well-being. We examined two possible models of the role of intrusive thoughts on the relationship between a supportive family environment and both depression and anxiety in a sample of 75 patients with end-stage renal disease (ESRD) waiting for a kidney transplant. Path analyses provided modest support for a mediational model, showing that intrusive thoughts partly accounted for the relationship between family expressiveness and psychological distress. A moderational model examining the interactive effects of family environment and intrusive thinking on adjustment was not supported.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kuhn WF, Davis MH, Lippman SB: Emotional adjustment to cardiac transplantation.General Hospital Psychiatry. 1988,10:108–113.
Levenson JL, Olbrisch ME: Shortage of donor organs and long waits.Psychosomatics. 1987,28:399–403.
Sensky T: Psychosomatic aspects of end-stage renal failure.Psychotherapy and Psychosomatics. 1993,59:56–58.
Greene AF, Sears SF: Psychometric assessment of cardiac transplantation candidates.Journal of Clinical Psychology in Medical Settings. 1994,1(2):135–147.
Kugler J, Tenderich G, Stahlut P, et al: Emotional adjustment and perceived locus of control in heart transplant recipients.Journal of Psychosomatic Research. 1994,38:403–408.
Christensen AJ, Holman JM, Turner CW, et al: A prospective study of quality of life in end-stage renal disease: Effects of cadaveric renal transplantation.Clinical Transplantation. 1991,5:40–47.
Sensky T: Psychiatric morbidity in renal transplantation.Psychotherapy and Psychosomatics. 1989,52:41–46.
Cohen S, Wills TA: Stress, social support, and the buffering hypothesis.Psychological Bulletin. 1985,98:310–357.
Wortman CB, Conway TL: The role of social support in adaptation and recovery from physical illness. In Cohen S, Syme SL (eds),Social Support and Health. New York: Academic Press, 281–302.
Christensen AJ, Moran PJ: Psychosomatic research in end-stage renal disease: A framework for matching patient to treatment.Journal of Psychosomatic Research. 1998,44:523–528.
Christensen AJ, Turner CW, Slaughter JR, Holman JM: Perceived family support as a moderator of psychological well-being in end-stage renal disease.Journal of Behavioral Medicine. 1998,12:249–265.
Moos RH, Moos BS:Family Environment Scale Manual (2nd Ed.). Palo Alto, CA: Consulting Psychologists Press, 1986.
Burton HJ, Lindsay RM, Kline SA: Social support as a mediator of psychological dysfunction and a determinant of renal failure outcomes.Clinical and Experimental Dialysis. 1983,7(4):371–389.
Siegal BR, Calsyn RJ, Cuddihee RM: The relationship of social support to psychological adjustment in end-stage renal disease patients.Journal of Chronic Disease. 1987,40:337–344.
Christensen AJ, Smith TW, Turner CW, et al: Family support, physical impairment, and adherence in hemodialysis: An investigation of main and buffering effects.Journal of Behavioral Medicine. 1992,15:313–325.
Christensen AJ, Wiebe JS, Smith TW, Turner CW: Predictors of survival among hemodialysis patients: Effect of perceived family support.Health Psychology. 1994,13:521–525.
Dimond M: Social support and adaptation to chronic illness: The case of maintenance hemodialysis.Research in Nursing and Health. 1979,2:101–108.
Barrera M: Distinctions between social support concepts, measures, and models.American Journal of Community Psychology. 1986,14:413–445.
Druley JA, Townsend AL: Self-esteem as a mediator between spousal support and depressive symptoms: A comparison of healthy individuals and individuals coping with arthritis.Health Psychology. 1998,17:255–261.
Duncan TE, McAuley E: Social support and efficacy cognitions in exercise adherence: A latent growth curve analysis.Journal of Behavioral Medicine. 1993,16:199–218.
Horowitz MK: Stress response syndromes and their treatment. In Goldberger L, Breznitz S (eds),Handbook of Stress: Theoretical and Clinical Aspects. New York: Free Press, 1982, 711–732.
Baum A: Stress, intrusive imagery, and chronic distress.Health Psychology. 1990,9:653–675.
Baider L, De-Nour AK: Psychological distress and intrusive thoughts in cancer patients.Journal of Nervous and Mental Disease. 1997,185:346–348.
Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology. 1986,51:1173–1182.
Lepore SJ, Silver RC, Wortman CB, Wayment HA: Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers.Journal of Personality and Social Psychology. 1996,70:271–282.
Lepore SJ, Helgeson VS: Social constraints, intrusive thoughts, and mental health after prostate cancer.Journal of Social and Clinical Psychology. 1998,17:89–106.
United States Renal Data System:USRDS 1998 Annual Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Diseases, 1998.
United Network of Organ Sharing:1997 Annual Report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network—Transplant Data: 1988–1996. Richmond, VA and Rockville, MD: UNOS and the Division of Transplantation, Office of Special Programs, Health Resources and Services Administration, U.S. Department of Health and Human Services, 1997.
Holahan CJ, Moos RH: The quality of social support: Measures of family and work relationships.British Journal of Clinical Psychology. 1983,22:157–162.
Horowitz M, Wilner N, Alvarez W: Impact of events scale: A measure of subjective stress.Psychosomatic Medicine. 1979,41:209–218.
Zilberg N, Weiss D, Horowitz M: Impact of event scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes.Journal of Consulting and Clinical Psychology. 1982,50:407–414.
Beck A, Ward C, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression.Archives of General Psychiatry. 1961,4:561–571.
Beck A, Steer R, Garbin M: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.Clinical Psychology Review. 1988,8:77–100.
Spielberger CD, Gorsuch RL, Lushene RE:Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, 1970.
Schaefer C, Coyne JC, Lazarus RS: The health-related functions of social support.Journal of Behavioral Medicine. 1981,4:381–406.
Wallston BS, Alagna SW, DeVellis BM, DeVellis RF: Social support and physical health.Health Psychology. 1983,2:367–391.
Christensen AJ, Moran PJ, Lawton WJ, Stallman D, Voigts AL: Monitoring attentional style and medical regimen adherence in hemodialysis patients.Health Psychology. 1997,16:256–262.
Pennebaker JW: Putting stress into words: Health, linguistic, and therapeutic implications.Behaviour Research and Therapy. 1993,31:539–548.
Clark LF: Stress and the cognitive-conversational benefits of social interaction.Journal of Social and Clinical Psychology. 1993,12:25–55.
Coyne JC: Depression and the response of others.Journal of Abnormal Psychology. 1976,85:186–193.
Joiner TE, Alfano MS, Metalsky GI: When depression breeds contempt: Reassurance seeking, self-esteem, and rejection of depressed college students by their roommates.Journal of Abnormal Psychology. 1992,101:165–173.
Ironson G, LaPerriere A, Antoni M, et al: Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status.Psychosomatic Medicine. 1990,52:247–270.
Spiegel D, Bloom J, Kraemer H, Gottheil E: Effect of psychosocial treatment on survival of patients with metastatic breast cancer.Lancet. 1989,2:888–891.
Pennebaker JW, Barger SD, Tiebout J: Disclosure of traumas and health among Holocaust survivors.Psychosomatic Medicine. 1989,51:577–589.
Author information
Authors and Affiliations
Additional information
Preparation of this manuscript was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases grant DK49129 awarded to Alan Christensen.
We gratefully acknowledge the assistance of Rachel Burke and Barbara Schanbacher in conducting this research.
About this article
Cite this article
Moran, P.J., Christensen, A.J., Ehlers, S.L. et al. Family environment, intrusive ideation, and adjustment among renal transplant candidates. ann. behav. med. 21, 311–316 (1999). https://doi.org/10.1007/BF02895963
Issue Date:
DOI: https://doi.org/10.1007/BF02895963