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The psychological well-being of end stage renal disease (ESRD) patients and spouses was investigated from a dyadic perspective. The responses of patients and spouses from five groups of couples--illustrating different points in the progression and treatment of ESRD--were compared both across ESRD groups and between patients and spouses. It was hypothesized that those ESRD groups with the highest levels of illness/treatment intrusiveness, i.e. the two dialysis groups, would exhibit the highest levels of marital role strain and concomitantly the lowest levels of psychological well-being. Despite the fact that the ESRD groups did reflect differences in perceived illness/treatment intrusiveness, no significant differences were found between the ESRD groups, or between patients and spouses, in either marital relations or psychological well-being. However, multiple regression analyses did indicate that marital role strain was a significant predictor of psychological well-being. It explained psychological well-being variance above and beyond demographic, physical health, ESRD group membership and psychological defensiveness considerations. Also, the two dialysis groups evidenced significantly greater correlations between marital role strain and psychological distress than the nondialysis groups. These findings were interpreted as being consistent with a General Systems Theory approach to the conceptualization and treatment of chronic illness.

End-stage renal disease (ESRD) and its treatment are generally considered to be highly stressful and the associated loss of control over important life dimensions is believed to induce widespread depression. This situation was employed as a "living stress laboratory" in which to test the reformulated learned helplessness theory of depression. Results indicated that reduced perceived control over a variety of life dimensions was importantly related to increased depression, although the attributional reformulation of helplessness theory was not supported. Moreover, reanalyses of these data from a social learning theory perspective indicated that perceived self-efficacy contributed uniquely to this negative correlation in addition to expectancies regarding response-outcome contingency (Rotter I-E scores). The hypothesis that the negative correlation between depression and perceived control might also be explained in terms of patients' psychological differentiation and the intrusiveness of ESRD was subsequently examined. Results revealed that perceived intrusiveness contributed uniquely to perceived control and to affect, indicating that perceived control and intrusiveness each contribute independently to mood. Surprisingly, a low prevalence of clinical depression was observed, contradicting the general consensus that helplessness and depression are unavoidable psychological sequelae to ESRD. These findings are equally applicable to several other chronic and life-threatened patient populations (e.g., cancer, cardiac, diabetic) and thus underline the need for a general theory of the emotional impact of illness.

Thesis (M.P.H.)--University of Hong Kong, 2007.

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references. Also available in print.

Thesis (Ph.D.) - University of Glasgow, 2008. / Ph.D. thesis submitted to the Faculty of Medicine, Division of Cardiovascular and Medical Sciences, University of Glasgow, 2007. Includes bibliographical references. Print version also available.

Thesis (M. P. H.)--University of Hong Kong, 2007. / Also available in print.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2008. / Advisor: Patricia Crane; submitted to the School of Nursing. Title from PDF t.p. (viewed Jun. 4, 2009). Includes bibliographical references (p. 130-143).

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.S.A.)--University of Michigan, 1976.