Studying psychosocial adaptation to end-stage renal disease: empirical model development and evaluation

Studying psychosocial adaptation in end-stage renal disease (ESRD) is increasingly important in explaining the variability in health outcomes unaccounted for by clinical factors alone. An empirically validated model is needed for guiding this body of research. The broad objective of this thesis is to study psychosocial adaptation in ESRD by validating a biopsychosocial model and examining the impact of psychosocial factors in ESRD across the developmental stages, namely, predialysis, early and long-term dialysis. This thesis employed meta-regression analysis, factor analysis, and structural equation modelling (SEM); and examined twelve latent variables: quality of life (QoL), depression, positive affect, medical comorbidity, kidney disease symptom status, illness accommodation, physical functioning, kidney-disease-related loss (KDRL), self-efficacy, illness acceptance, social support, and haemoglobin.The systematic and meta-analytic reviews identified the strength of the overall associations of psychosocial factors to depression and QoL to be at a medium level, with cognitive appraisal and personality attributes having the largest associations with depression; and stress, affect and cognitive appraisal having the largest associations with QoL. The results supported the validity and reliability of Kidney Disease Loss Scale and that KDRL in ESRD is a distinct construct which may contribute to the level of depression. The results of the SEM analyses supported the validity and consistency of the proximal-distal model. It provided an empirical framework for integrating clinical, functional, psychosocial factors and health outcomes in ESRD. The findings demonstrated that a biopsychosocial model, formed by adding psychosocial factors onto the proximal-distal model, was valid for studying psychosocial adaptation and varied with the developmental stages. Among the psychosocial factors, illness acceptance had the least impact. Social support, KDRL, self-efficacy, and illness accommodation affected kidney disease symptom status, physical functioning, depression, positive affect, and QoL differently at each of the developmental stages. This thesis validated an empirical model for studying psychosocial adaptation to ESRD; supported the evolving and dynamic nature of psychosocial adaptation, and demonstrated the importance of psychosocial factors in determining health outcomes in patients with ESRD across the developmental stages. The results also supported the possible development of psychosocial support programs for patients with ESRD to improve their health outcomes