Coping styles and depression in an end-stage renal disease population: Prediction of adaptation following transplantation

It has been hypothesized that stress due to end-stage renal disease (ESRD) may overwhelm coping mechanisms and lead to higher levels of depression. Coping styles and depression were evaluated in cross-sectional study of transplant candidates (Study I). ESRD patients who are depressed may have difficulty complying with their treatment regimen, which may affect the course of their physical illness. The utility of coping and depression in the prediction of compliance, physical outcome, and psychological status following transplantation was assessed in Study II.Subjects for Study I were 288 adolescents and adults with ESRD who were candidates for transplantation. Transplant candidates were found to use adaptive coping methods more frequently than maladaptive coping methods. The use of maladaptive coping styles was significantly associated with greater levels of depression prior to transplantation. Sociodemographic variables were associated with the variables of coping and depression; older subjects and those with higher levels of education were more likely to cope adaptively and less likely to have clinically significant levels of depression. Hispanic and Black subjects were more likely to use maladaptive styles of coping.Study II included 71 subjects, ranging in age from 13 to 82, who had received a kidney transplant. Compliance with treatment, health outcome, and levels of post-transplant depression were measured. The pre-transplant variables of older age, higher levels of education, and more frequent use of Active Coping were predictive of a better health outcome following transplantation. Levels of pre-transplant depression significantly predicted post-transplant depression.Overall, the results suggested that prior to transplantation, some groups of transplant candidates may be more at risk for psychological difficulties than others. Sociodemographic characteristics, styles of coping, and levels of depression may be indicative of post-transplant adjustment. Whether intervention aimed at these variables prior to transplantation may have a beneficial effect on post-transplant outcome remains to be determined.