بررسی ارتباط تبعیت از درمان با افسردگی، اضطراب و راهبردهای مقابله‌ای در بیماران پیوند کلیه

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، مرکز تحقیقات علوم رفتاری و گروه روان‌پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، مرکز تحقیقات روان‌تنی و گروه روان‌پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشجوی پزشکی، کمیته‌ی تحقیقات دانشجویی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 استادیار، مرکز تحقیقات روان‌تنی و گروه روان‌پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

5 دانشیار، مرکز تحقیقات بیماری‌های کلیه و گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: یکی از عوامل مؤثر در ماندگاری کلیه‌ی پیوند شده، تبعیت کامل بیمار از دستورهای دارویی است، اما برخی پژوهش‌ها نشان داده است که بعضی بیماران، به علل مختلف از جمله علل روان‌شناختی، پیروی کامل از دستورهای دارویی ندارند. مطالعه‌ی حاضر با هدف تعیین ارتباط بین تبعیت از درمان در بیماران تحت پیوند کلیه با عوامل روان‌شناختی شامل افسردگی، اضطراب و راهبرد‌های مقابله‌ای آنان به انجام رسید.روش‌ها: طی یک مطالعه‌ی مقطعی در سال 1394 در مراکز آموزشی- درمانی الزهرا (س) و نور و حضرت علی‌اصغر (ع) شهر اصفهان، 85 بیمار تحت پیوند کلیه از نظر ارتباط بین تابعیت از درمان و عوامل روان‌شناختی از جمله افسردگی، اضطراب و راهبرد‌های مقابله‌ای با استفاده از پرسش‌نامه‌های اضطراب و افسردگی بیمارستان (Hospital Anxiety and Depression Scale یا HADS)، راهبرد‌های مقابله‌ای (Brief coping strategy questionnaire یا Brief COPE) و پرسش‌نامه‌ی ساده شده‌ی تبعیت از درمان (Simplified medication adherence questionnaire یا SMAQ) مورد بررسی قرار گرفتند.یافته‌ها: 43 بیمار (6/50 درصد) دارای همکاری و 42 بیمار (4/49 درصد) فاقد همکاری (چسبندگی به درمان) بودند. میانگین نمره‌ی اضطراب در بیماران با و بدون همکاری اختلاف معنی‌داری بین دو گروه نشان نداد (210/0 = P)، اما میانگین نمره‌ی افسردگی در بیمارانی که عدم همکاری داشتند، به ‌طور معنی‌داری بالاتر بود (043/0 = P). میانگین نمره‌ی خرده آزمون مذهب از آزمون مقابله با استرس، در گروه دارای همکاری به ‌طور معنی‌داری بالاتر بود (039/0 = P).نتیجه‌گیری: میزان تبعیت بیمار از درمان در بیماران تحت کلیه‌ی پیوندی، به میزان زیادی به شدت افسردگی بستگی دارد و توجه و تمرکز بیشتر بر روی درمان افسردگی ضروری به نظر می‌رسد.

کلیدواژه‌ها

عنوان مقاله [English]

The Relationship of Drug Compliance with Depression, Anxiety and Coping Strategies in Patients with Kidney Transplantation

نویسندگان [English]

  • Victoria Omranifard 1
  • Amrollah Ebrahimi 2
  • Taysir Basti 3
  • Mohammad Reza Sharbafchi 4
  • Shahram Sajjadieh 5
  • Mojgan Mortazavi 5
1 Associate Professor, Behavioral Sciences Research Center AND Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Psychosomatic Research Center AND Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Assistant Professor, Psychosomatic Research Center AND Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
5 Associate Professor, Kidney Disease Research Center AND Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: One of the influent factors in successful kidney transplantation is complete drug compliance in patients; but some of the studies had shown that some patients are not fully compliant because of several reasons including psychological factors. This study aimed to assess the relationship of the drug compliance in patient with kidney transplantation with psychological factors including depression, anxiety and coping strategies.Methods: In a cross-sectional study during 2015-2016 in Alzahra and Noor and Aliasghar Hospitals in Isfahan, Iran, 85 patients with kidney transplantation were assessed in terms of relationship of drug compliance with psychological factors such as depression, anxiety and coping strategies using Hospital Anxiety and Depression Scale (HADS), Brief COPE (coping strategy) inventory and the simplified medication adherence questionnaire (SMAQ).Findings: In this study, 43 patients (50.6%) were compliant and 42 patients (49.4%) were noncompliant. The mean score of anxiety showed no significant difference between the two groups (P = 0.210), but the mean score of depression was significantly higher in noncompliant group (P = 0.043). The mean score of religious sub scale of coping strategies was higher in compliant group significantly (P = 0.039).Conclusion: According to this study, drug compliance in patients with kidney transplantation is related to depression significantly and diagnosis and treatment of depression is very important in these patients.

کلیدواژه‌ها [English]

  • Patient Compliance
  • Anxiety
  • Depression
  • Coping skills
  • Kidney transplantation

مراجع

  1. Konkle-Parker DJ. A motivational intervention to improve adherence to treatment of chronic disease. J Am Acad Nurse Pract 2001; 13(2): 61-8.
  2. Hansen R, Seifeldin R, Noe L. Medication adherence in chronic disease: issues in posttransplant immunosuppression. Transplant Proc 2007; 39(5): 1287-300.
  3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353(5): 487-97.
  4. Sackett DL, Snow JC. The magnitude of adherence and non-adherence. In: Haynes RB, Sackett DL, editors. Compliance in health care. 1st ed. Baltimore, MD: Johns Hopkins University Press; 1979. p. 207-25.
  5. Senst BL, Achusim LE, Genest RP, Cosentino LA, Ford CC, Little JA, et al. Practical approach to determining costs and frequency of adverse drug events in a health care network. Am J Health Syst Pharm 2001; 58(12): 1126-32.
  6. Wainwright SP, Gould D. Non-adherence with medications in organ transplant patients: a literature review. J Adv Nurs 1997; 26(5): 968-77.
  7. Kim JH, Kim GS, Kim EJ, Park S, Chung N, Chu SH. Factors affecting medication adherence and anticoagulation control in Korean patients taking warfarin. J Cardiovasc Nurs 2011; 26(6): 466-74.
  8. Emilsson M, Berndtsson I, Lotvall J, Millqvist E, Lundgren J, Johansson A, et al. The influence of personality traits and beliefs about medicines on adherence to asthma treatment. Prim Care Respir J 2011; 20(2): 141-7.
  9. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 1999; 47(6): 555-67.
  10. Loghman-Adham M. Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Am J Manag Care 2003; 9(2): 155-71.
  11. Khalkhali H, Hajizadeh E, Kazemnezad A, Ghafari A. The prediction's trend of graft survival in renal transplantation with chronic allograft dysfunction. Iran J Epidemiol 2010; 6 (2) :25-31. [In Persian].
  12. Shahkhodabandeh S, Piri Z, Biglo Mh, Asadi M, Chakhmachi Dovom N. Breast cancer in Iran: Iranian scientists approach to breast cancer researches in Medline database. Iran J Breast Dis 2009; 2(2): 49-59. [In Persian].
  13. Fraser SD, Blakeman T. Chronic kidney disease: identification and management in primary care. Pragmat Obs Res 2016; 7: 21-32.
  14. Jiang H, Han J, Zhu Z, Xu W, Zheng J, Zhu Y. Patient compliance with assessing and monitoring of asthma. J Asthma 2009; 46(10): 1027-31.
  15. Henin E, Tod M, Trillet-Lenoir V, Rioufol C, Tranchand B, Girard P. Pharmacokinetically based estimation of patient compliance with oral anticancer chemotherapies: in silico evaluation. Clin Pharmacokinet 2009; 48(6): 359-69.
  16. Kazimierczak K, Kazimierczak I, Weyde W, Zmonarski S, Grybos M, Klinger M. Immunosuppressive drug therapy during pregnancy after kidney transplantation. Ginekol Pol 2005; 76(7): 586-92. [In Polish].
  17. Katzung BG. Basic and Clinical Pharmacology. 9th ed. New York, NY: McGraw-Hill; 2004. p. 327-9, 645, 899-907.
  18. Neame R, Hammond A. Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford) 2005; 44(6): 762-7.
  19. Jansa M, Hernandez C, Vidal M, Nunez M, Bertran MJ, Sanz S, et al. Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital. Patient Educ Couns 2010; 81(2): 161-8.
  20. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002; 288(22): 2868-79.
  21. Henin E, You B, Tranchand B, Freyer G, Girard P. Issues of the study of patient compliance to treatment with oral anticancer chemotherapy: advantages of pharmacokinetics-pharmacodynamics modelisation. Therapie 2007; 62(2): 77-85. [In French].
  22. Mardby AC, Akerlind I, Jorgensen T. Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Educ Couns 2007; 69(1-3): 158-64.
  23. Gottlieb S, Behar S, Schwartz R, Harpaz D, Shotan A, Zahger D, et al. Age differences in the adherence to treatment guidelines and outcome in patients with ST-elevation myocardial infarction. Arch Gerontol Geriatr 2011; 52(1): 118-24.
  24. Gili M, Roca M, Ferrer V, Obrador A, Cabeza E. Psychosocial factors associated with the adherence to a colorectal cancer screening program. Cancer Detect Prev 2006; 30(4): 354-60.
  25. Gatti ME, Jacobson KL, Gazmararian JA, Schmotzer B, Kripalani S. Relationships between beliefs about medications and adherence. Am J Health Syst Pharm 2009; 66(7): 657-64.
  26. Fawzi W, Abdel Mohsen MY, Hashem AH, Moussa S, Coker E, Wilson KC. Beliefs about medications predict adherence to antidepressants in older adults. Int Psychogeriatr 2012; 24(1): 159-69.
  27. Hagop S, Akiskal MD. Mood disorders: clinical features. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. Philadelphia, PA: Lippincott Williams and Wilkins; 2009. p. 1693-733.
  28. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: APA; 2013.
  29. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52(2): 69-77.
  30. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003; 1: 14.
  31. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997; 4(1): 92-100.
  32. World Health Organization. Process of translation and adaptation of instruments. [Online]. [cited 2012 Mar 11]; Available from: URL:
  33. http://www.who.int/substance_abuse/research_tools/translation/en.
  34. Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS 2002; 16(4): 605-13.
  35. Ortega Suarez FJ, Sanchez PJ, Perez Valentin MA, Pereira PP, Munoz Cepeda MA, Lorenzo AD. Validation on the simplified medication adherence questionnaire (SMAQ) in renal transplant patients on tacrolimus. Nefrologia 2011; 31(6): 690-6.
  36. Massey EK, Meys K, Kerner R, Weimar W, Roodnat J, Cransberg K. Young adult kidney transplant recipients: nonadherent and happy. Transplantation 2015; 99(8): e89-e96.
  37. Shabany HM, Mohamad AJ. Relationship between immunosuppressive medications adherence and quality of life and some patient factors in renal transplant patients in Iran. Glob J Health Sci 2014; 6(4): 205-12.
  38. Weng FL, Chandwani S, Kurtyka KM, Zacker C, Chisholm-Burns MA, Demissie K. Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: a cross-sectional study. BMC Nephrol 2013; 14: 261.
  39. Low JK, Williams A, Manias E, Crawford K. Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review. Nephrol Dial Transplant 2015; 30(5): 752-61.
  40. Prihodova L, Nagyova I, Rosenberger J, Majernikova M, Roland R, Groothoff JW, et al. Adherence in patients in the first year after kidney transplantation and its impact on graft loss and mortality: a cross-sectional and prospective study. J Adv Nurs 2014; 70(12): 2871-83.
مجله دانشکده پزشکی اصفهان
دوره 34، شماره 409 - شماره پیاپی 409
بهمن و اسفند 1395
صفحه 1430-1438

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سابقه مقاله

  • تاریخ دریافت: 31 شهریور 1395
  • تاریخ بازنگری:
  • تاریخ پذیرش: 17 فروردین 1401

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