Depression is an independent risk factor of poor outcomes for Chronic Kidney Disease (CKD) patients. Perceived social support and alexithymia are psychosocial variables identified by previous studies as predictive of depression in normal controls and CKD patients. Repetitively thinking and socially sharing emotional experiences have been investigated in association with depression in normal populations. Our cross-sectional study aimed to assess the effects of perceived social support, alexithymia, mental rumination, and social sharing on depression in CKD patients and controls. 103 CKD patients (age = 61.9 ± 7.2, 54 men) and 101 controls (age = 64.51 ± 6.56; 47 men) completed a questionnaire of 5 sections: Pluridimensional Inventory for Haemodialysis Patients (IPPE), Multidimensional Scale of Perceived Social Support (MSPSS), Geriatric Depression Scale (GDS), Toronto Alexihymia Scale (TAS-20), Social Sharing and Mental Rumination. Multiple regression analysis models with dummy variables assessed the effects of IPPE, MSPSS, TAS-20, Social Sharing, and Mental Rumination on GDS across the subgroups of participants. SPSS software was used. Depression levels resulted higher for patients than controls, especially in patients dialyzed for less than 4 years. The effects of perceived social support and alexithymia differed with respect to the subsamples. Rumination was positively associated with depression in normal controls, but negatively related with depression in patients dialyzed for 4+ years. The study confirmed high levels of depression in CKD patients. Depression was influenced by perceive social support, alexithymia, and the cognitive elaboration of emotional troubles associated with the disease. Rumination appeared as a dysfunctional consequence of emotions for normal controls, but had an adaptive function for patients dialyzed for 4+ years
KeywordsDepressionPerceived Social SupportAlexithymiaMental RuminationSocial SharingCKD
Andresen, E. M., Malmgren, J. A., Carter, W. B., Patrick, D. L., & Radloff, L. S. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77-84.
Biasioli, S., & Ballaben, P. (2003). IPPE, inventario pluridimensionale per il paziente in Emodialisi. In Ospedale e Territorio. Roma: CIC Edizioni Internazionali.
Broderick, P. C., & Korteland, C. (2002). Coping style and depression in early adolescence: Relationships to gender, gender role, and im- plicit beliefs. Sex Roles, 46, 201-213. doi:10.1023/A:1019946714220
Cambron, M. J., Acitelli, L. K., & Pettit, J. W. (2009). Explaining gender differences in depression: An interpersonal contingent self-es- teem perspective. Sex Roles, 61, 651-661. doi:10.1007/s11199-009-9616-6
Cohen, S. D., Sharma, T., Acquaviva, K., Peterson, R. et al. (2007). Social support and chronic kidney disease: An update. Advances in Chronic Kidney Disease, 14, 335-344. doi:10.1053/j.ackd.2007.04.007
Conger, R. D., Lorenz, F. O., Elder, G. H. Jr. et al. (1993). Husband and wife differences in response to undesirable life events. Journal of Health and Social Behavior, 34, 71-88. doi:10.2307/2137305
Craven, J. L., Rodin, G. M., & Littlefield, C. (1988). The Beck Depression Inventory as a screening device for major depression in renal dialysis patients. International Journal of Psychiatry, 18, 365-374. doi:10.2190/M1TX-V1EJ-E43L-RKLF
Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823-865. doi:10.1037/0033-2909.132.6.823
Gignac, G. E., Palmer, B. R., & Stough, C. (2007). A confirmatory factor analytic investigation of the tas-20: Corroboration of a five-factor model and suggestions for improvement. Journal of Per- sonality Assessment, 89, 247-257. doi:10.1080/00223890701629730
Grabe, H. J., Spitzer, C., & Freyberger, H. J. (2004). Alexithymia and personality in relation to dimensions of psychopathology. The American Journal of Psychiatry, 161, 1299-1301. doi:10.1176/appi.ajp.161.7.1299
Grigoriadis, S., & Robinson, G. E. (2007). Gender issues in depression. Annals of Clinical Psychiatry, 19, 247-255. doi:10.1080/10401230701653294
Hedayati, S. S., Bosworth, H., Briley, L. et al. (2008). Death or hospitalization of patients on chronic haemodialysis is associated with a physician-based diagnosis of depression. Kidney International, 74, 930-936. doi:10.1038/ki.2008.311
Hedayati, S. S., Minhajuddin, A. T., Toto, R. D. et al. (2009). Prevalence of major depressive disorder in CKD. American Journal of Kidney Disease, 54, 424-432. doi:10.1053/j.ajkd.2009.03.017
Hedayati, S. S., Minhajuddin, A. T., Afshar, M., Toto, R. D. et al. (2010). Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA, 303, 1946-1953. doi:10.1001/jama.2010.619
Hendryx, M. S., Haviland, M. G., & Shaw, D. G. (1991). Dimensions of alexithymia and their relationships to anxiety and depression. Journal of Personality Assessment, 56, 227-237. doi:10.1207/s15327752jpa5602_4
Hoth, K. F., Christensen, A. J., Ehlers, S. L., Raichle, K. A., & Laweton, W. J. (2007). A longitudinal examination of social support, agreeableness and depressive symptoms in chronic kidney disease. Journal of Behavioral Medicine, 30, 69-76. doi:10.1007/s10865-006-9083-2
Kauhanen, J., Kaplan, G. A., Cohen, R. D., Julkunen, J., & Salonen, J. T. (1996). Alexithymia and risk of death in middle-aged men. Journal of Psychosomatic Research, 41, 541-549. doi:10.1016/S0022-3999(96)00226-7
Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex differences in the relationship between social support and risk for major depression: A longitudinal study of opposite-sex twin pairs. American Journal of Psychiatry, 162, 250-256. doi:10.1176/appi.ajp.162.2.250
Kojima, M., Hayano, J. et al. (2010). Depression, alexithymia and long-term mortality in chronic haemodialysis patients. Psychotherapy and Psychosomatics, 79, 303-11. doi:10.1159/000319311
Kojima, M., Hayano, J., Tokudome, S. et al. (2007). Independent asso- ciations of alexithymia and social support with depression in haemodialysis patients. Journal of Psychosomatic Research, 63, 349-356. doi:10.1016/j.jpsychores.2007.04.002
Kooiman, C. G., Spinhoven. P., & Trijsburg, R. W. (2002). The assessment of alexithymia—A critical review of the literature and a psychometric study of the Toronto Alexithymia Scale-20. Journal of Psychosomatic Research, 53, 1083-1090. doi:10.1016/S0022-3999(02)00348-3
Kübler-Ross, E. (2009). On Death and Dying, 40th anniversary edition. Abingdon: Routledge.
Lane, R. D., Sechrest, L., & Riedel, R. (1998). Sociodemographic correlates of alexithymia. Comprehensive Psychiatry, 39, 377-385. doi:10.1016/S0010-440X(98)90051-7
Leach, L. S., Christensen, H., Mackinnon, A. J., Windsor, T. D., & Butterworth, P. (2008). Gender differences in depression and anxiety across the adult lifespan: The role of psychosocial mediators. Social Psychiatry and Psychiatric Epidemiology, 43, 983-998. doi:10.1007/s00127-008-0388-z
Leichtman A. B., Cohen, D., Keith, D., O’Connor et al. (2008). Kidney and pancreas transplantation in the United States, 1997-2006: The HRSA breakthrough collaborative and the 58 DSA challenge. American Journal of Transplantation, 8, 946-957. doi:10.1111/j.1600-6143.2008.02173.x
Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G. (2007). An empirical examination of the stage theory of death. JAMA, 297, 716-723. doi:10.1001/jama.297.7.716
Marchesi, C., Brusamonti, E., & Maggini, C. (2000). Are alexithymia, depression, and anxiety distinct constructs in affective disorders? Journal of Psychosomatic Research, 49, 43-49. doi:10.1016/S0022-3999(00)00084-2
Martin, L. L., & Tesser, A. (1989). Toward a motivational and struc- tural theory of ruminative thought. In J. S. Uleman, & J. A. Bargh (Eds.), Unintended thoughts (pp. 306-325). New York: Guilford.
Mezulis, A. H., & Fanasaki, K. (2009). Modeling the gender difference in depression: A commentary on Cambron, Acitelli, and Pettit. Sex Roles, 61, 672-678. doi:10.1007/s11199-009-9663-z
Miskulin, D. C., Meyer, K. B. et al. (2003). Choices for Healthy Out- comes in Caring for End-Stage Renal Disease (CHOICE) study. Comorbidity and its change predict survival in incident dialysis patients. American Journal of Kidney Disease, 41, 149-161. doi:10.1053/ajkd.2003.50034
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569-582. doi:10.1037/0021-843X.100.4.569
Nolen-Hoeksema, S., & Morrow, J. (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition & Emotion, 7, 561-570. doi:10.1080/02699939308409206
Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depression. Journal of Personality and Social Psychiatry, 77, 1061-1072. doi:10.1037/0022-3514.77.5.1061
Parker, J. D., Taylor, G. J., & Bagby, R. M. (2003). The 20-Item Toronto Alexithymia Scale III. Reliability and factorial validity in a community population. Journal of Psychosomatic Research, 55, 269-275. doi:10.1016/S0022-3999(02)00578-0
Ricardo, A. C., Fischer, M. J., Peck, A. et al. (2010). Depressive symptoms and chronic kidney disease: Results from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. International Urology and Nephrology, 42, 1063-1068. doi:10.1007/s11255-010-9833-5
Rimé, B. (2009). Emotion elicits the social sharing of emotion: Theory and empirical review. Emotion Review, 1, 60-85. doi:10.1177/1754073908097189
Rimé, B., Mesquita, B., Philippot, P., & Boca, S. (1991). Beyond the emotional event: Six studies on the social sharing of emotion. Cognition & Emotion, 5, 435-465. doi:10.1080/02699939108411052
Roberts, J. E., Gilboa, E., & Gotlib, I. H. (1998). Ruminative response style and vulnerability to episodes of dysphoria. Cognitive Therapy and Research, 22, 401-423. doi:10.1023/A:1018713313894
Sarason, I. G., & Sarason, B. R. (2009). Social support: Mapping the construct. Journal of Social and Personal Relationships, 26, 113- 120. doi:10.1177/0265407509105526
Schipper, K., & Abma, T. A. (2011). Coping, family and mastery: Top priorities for social science research by patients with chronic kidney disease. Nephrololgy Dialysis Transplantation, 26, 3189-3195. doi:10.1093/ndt/gfq833
Taylor, G. J. (1994). The alexithymia construct: Conceptualization, validation, and relationship with basic dimensions of personality. New Trends in Experimental and Clinical Psychiatry, 10, 61-74.
Umberson, D., Wortman, C., & Kessler, R. (1992). Widowhood and depression: Explaining long term gender differences in vulnerability. Journal of Health and Social Behavior, 33, 10-24. doi:10.2307/2136854
Watkins, E., & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression. Journal of Abnormal Psychology, 110, 353- 357. doi:10.1037/0021-843X.110.2.333
Watnick, S. (2007). Depression in the end-state renal disease population on dialysis. US Nephrology, 1, 89-91.
Watnick, S., Wang, P., Demadura, T., & Ganzini, L. (2005). Validation of two depression screening tools in dialysis. American Journal of Kidney Disease, 46, 919-924. doi:10.1053/j.ajkd.2005.08.006
Weissman, M. M., Bland, R. C., Canino, G. J. et al. (1996). Cross- national epidemiology of major depression and bipolar disorder. JAMA, 276, 293-299. doi:10.1001/jama.276.4.293
Yesavage, J. A., Brink, T. L., Rose, T. L. et al. (1983). Development and validation of a geriatric depression screening scale: A preli- minary report. Journal of Psychiatric Research, 17, 37-49. doi:10.1016/0022-3956(82)90033-4
Zech, E., & Rimé, B. (2005). Is talking about an emotional experience helpful? Effects on emotional recovery and perceived benefits. Clinical Psychology and Psychotherapy, 12, 270-287. doi:10.1002/cpp.460
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30-41. doi:10.1207/s15327752jpa5201_2