Health-Related Quality of Life in pre-dialysis patients with chronic kidney disease: the role of Big-Five personality traits and illness denial

Abstract

Background Health-Related Quality of Life (HRQoL) in patients with chronic kidney disease (CKD) is significantly affected, regardless of the stage of the disease, as regards the physical, psychological and social functioning dimension. Big-Five personality traits can affect patients’ HRQoL and willingness to take treatment options. Illness denial consists of denial of negative emotions, resistance to change and conscious avoidance. Poorer HRQoL can predict a higher risk of hospitalization and mortality, and broadly a worse adjustment to the dialytic therapy. Thus, a clearer knowledge of the psychological variables associated with a worse HRQoL in the predialysis stage might improve the intervention planning. No study investigated illness denial and personality traits simultaneously. We investigated the role of illness denial and Big-Five personality traits in the domains of HRQoL in predialysis patients with CKD. Methods One hundred adults (mean age: 75.87 years) with CKD participated. The Kidney Disease Quality of Life Short form, the Italian version of Ten Item Personality Inventory Revised, the Illness Denial Questionnaire, and the State-Trait Anxiety Inventory Form-Y were administered. Results Illness denial was associated with increased HRQoL related to symptoms/problems, effect and burden of CKD and cognitive functions domains, and it was a predictor of higher HRQoL in the last three domains mentioned above. Extraversion was related to better work status and sexual function; agreeableness was linked to elevated cognitive function, quality of social interaction and sexual function; conscientiousness was related to better sexual function; neuroticism was linked to improved cognitive and sexual functions; in the end, openness to experience was related to fewer symptoms and problems. Conclusions This is the first study which simultaneously assessed Big-Five personality traits and illness denial in different domains of HRQoL of CKD patients. Personalised psychological interventions aimed at improving HRQoL in this population might focus on specific illness denial processes and personality traits.

Illness Denial in Medical Disorders: A Systematic Review

“…Similarly, in a study with end-stage renal disease patients, Fricchione et al [126] showed that those with low levels of illness denial were more sensitive, had more anxiety and depression, and also reported greater sleep disturbances than patients with high levels of illness denial. In a more recent study involving pre-dialysis patients with chronic kidney disease, Pugi et al [127] found that illness denial was a significant predictor of higher levels of health-related quality of life. The authors showed that chronic kidney disease patients with illness denial were not bothered by the effects of the kidney disease on daily life, did not perceive high levels of frustration and interference of kidney disease in their life, did not report any concentration problems or mental confusion [127].…”

“…In a more recent study involving pre-dialysis patients with chronic kidney disease, Pugi et al [127] found that illness denial was a significant predictor of higher levels of health-related quality of life. The authors showed that chronic kidney disease patients with illness denial were not bothered by the effects of the kidney disease on daily life, did not perceive high levels of frustration and interference of kidney disease in their life, did not report any concentration problems or mental confusion [127]. In a cross-sectional investigation involving hemodialysis patients, however, Carvalho et al [128] showed that illness denial was associated with impaired health-related quality of life.…”

“…It may help a person cope with various phases of illness and treatment by allowing time to process and dilute distressing information at a manageable rate, as was found to occur in cancer [209]. Patients who had low levels of denial did not delay in reporting their symptoms to the medical attention, did not require outside help to seek medical help, were more likely to exhibit health-promoting attitudes and behavior, and had more favorable clinical outcomes [27, 37, 53, 56, 57, 59, 118, 119, 126, 127, 161, 173, 175, 176]. Denying the burden of physical disease may indeed be an adaptive coping mechanism in some circumstances and at certain degrees, as in the early stages of the disease, for example, immediately after diagnosis, or in the terminal phase of a life-threatening disease because it may alleviate psychological distress, as well as symptoms of anxiety and depression [25, 37, 49, 52, 210].…”

“…Denying the burden of physical disease may indeed be an adaptive coping mechanism in some circumstances and at certain degrees, as in the early stages of the disease, for example, immediately after diagnosis, or in the terminal phase of a life-threatening disease because it may alleviate psychological distress, as well as symptoms of anxiety and depression [25, 37, 49, 52, 210]. Illness denial may also improve clinical outcomes [56, 59, 68, 127, 159, 161, 173, 175]. The following clinical findings exemplify these phenomena: (1) unstable angina pectoris patients with illness denial were more likely to reach medical stabilization [56], (2) illness denial was a significant predictor of good recovery in cardiac patients with myocardial infarction [59], (3) chronic pain patients with illness denial reported lower levels of disability [68], (4) in patients with chronic kidney disease illness denial predicted higher levels of health-related quality of life [127], (5) patients who had initially reacted to cancer by denial were significantly more likely to be alive and free of recurrence at a 5-year follow-up evaluation and had significantly higher levels of serum immunoglobulins IgM than either those who responded with fighting spirit or stoic acceptance [173], (6) illness denial was a significant predictor of longer survival in breast cancer patients and in those with localized melanoma [159, 161, 175].…”

“…Illness denial may also improve clinical outcomes [56, 59, 68, 127, 159, 161, 173, 175]. The following clinical findings exemplify these phenomena: (1) unstable angina pectoris patients with illness denial were more likely to reach medical stabilization [56], (2) illness denial was a significant predictor of good recovery in cardiac patients with myocardial infarction [59], (3) chronic pain patients with illness denial reported lower levels of disability [68], (4) in patients with chronic kidney disease illness denial predicted higher levels of health-related quality of life [127], (5) patients who had initially reacted to cancer by denial were significantly more likely to be alive and free of recurrence at a 5-year follow-up evaluation and had significantly higher levels of serum immunoglobulins IgM than either those who responded with fighting spirit or stoic acceptance [173], (6) illness denial was a significant predictor of longer survival in breast cancer patients and in those with localized melanoma [159, 161, 175]. In these clinical situations, where illness denial may not only provide protection against painful and distressing experiences but also facilitate coping with difficult situations and improve both short- and long-term outcomes, it can be viewed as an adaptive process [16].…”