Prior to intervention, the scores of confronce subscale were significantly lower, while the scores of avoidance and resignation subscales were significantly higher in MHD patients than in healthy populations. But the mean score of no matter confronce or avoidance subscale was not high. This indicates that MHD patients generally lack of effective coping models, which is in accordance with previous findings[10-12].
Coping, as an intermediary factor of stress and health, plays an important regulatory role during the process of stress influencing mental healthy. How to cope stresses directly correlates physical and mental health. Effective coping mode maintains physical and mental health and passive coping mode does harm for health. Confronce is usually considered a most active coping mode, which makes patients concern disease condition and do their best to cure this disease. But there is slim hope for rehabilitation of MHD patients. In addition, most MHD patients have poor economics, with limited social functions, abundant, severe difficulties, and easy to have helpless feeling. Avoidance is to ignore the existence and severity of mental stress and to focus patients’ attention to meaningful, helpful matters, which can not solve the problems directly, but it can help forget pains temporarily, stabilize emotions, and search new methods to solve problems[13]. For MHD patients, avoidance is an effective coping mode. Resignation is a passive coping mode that can increase mental stress, which makes patients to be pessimistic, worldweary, resigned, and self-abandoned.
Results from this study revealed that MHD patients have poor mental health, presenting with total average score and average score of each factor of SCL-90 being > 2, showing a positive tendency, which is consistent with previous findings[14-15]. The average score of no matter somatization related to body condition or additional items related to sleep is over 3. This correlates with patients’ disease and lacks of effective coping mode.
After intervention, the scores of confronce and avoidance were significantly higher, while the scores of acceptance/resignation were significantly lower, as compared with the control group. At the same time, some scores were also significantly lower than those in the control group, total average score of SCL-90, the score of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, photic anxiety and additional items. These findings suggest that rational-emotive therapy can effectively amend the coping model and elevate the level of mental health. Because this therapy can help patients learn to self-estimate correctly, change irrational belief, thereby use more active coping mode, improve mental states, and alleviate negative emotion.
MHD patients survive depending on treatment. Treatment compliance is an important factor that influences therapeutic effects and patients’ quality of life. It is very common that MHD patients lack treatment compliance, and adherence to fluid restrictions is most difficult.
The change of body weight is the best index for judging adherence to fluid restriction. The interdialysis weight gain should be controlled within 1.5 kg for anuric patients. More than 40% of patients can not well comply with this requirement. Lack of adherence to fluid restrictions is a problem of health education and is also influenced by mental factors. Depression symptom and its severity are independent risk factors of non-adherence to fluid restrictions[3]. With alleviation of negative emotions including depression, patients present reduced self-defeating behaviors and learn to eliminate disturbance, thereby adherence to fluid restrictions is enhanced, as manifested by improvements in four clinical indices above-mentioned after intervention.
