DU Journal, Humanities and Social Sciences April 2015 Vol 8 (4) 92-103 http://dujournal.eu.

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Social Psychological Factors in Hemodialysis Patients: Correlation between Perceived

Social Support and Stress
Elham Davaridolatabadi a* and GholamHossein Abdeyazdanb
aElham Davaridolatabadi,Msc Of Critical Care Nursing , Department Of Nursing And
Midwifery, Young Researchers And Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad
University, Isfahan, Iran
bGholamHossein Abdeyazdan, MSc of nursing, Isfahan (Khorasgan) Branch, Islamic Azad
University, Isfahan, Iran
*Corresponding Author: Elham Davaridolatabadi
E-mail: nurse.davari@yahoo.com Mobil: 09131013475, Tell: 031-35354001

Received: 8 February 2015, Accepted: 19 March 2015, Available online: 20 April 2015

Abstract

Background and Objectives

Increasing population of patients undergoing hemodialysis is a global problem. Given that

studies on psychosocial outcomes in hemodialysis patients is very limited and low, this study
aimed to assess anxiety and perceived social support and the relationship between these two
factors in this group of patients.

Method

This study is cross sectional and was conducted in 2011. The study population included all
patients undergoing hemodialysis in Isfahan. After random selection hemodialysis, sampling was
done on purpose. A total of 126 patients were enrolled in this study. Data collection tools
included trait anxiety inventory status and perceived social support. Both the questionnaire had
good reliability and validity (r = 0.93) and (r = 0.895). Data using descriptive and inferential
statistical analysis was performed using SPSS software.

Findings

The results showed that 68.3 percent of participants had a moderate level of perceived support.
Also appreciate the support means to the lower size (average 40.02). Over half of the participants
suffer from a moderate level of state and trait anxiety (65 and 67.5 percent). Levels of state and
trait anxiety levels of perceived social support and emotional dimensions and information inverse
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relationship (r = -0.229, r = -0.340). There is highest correlation with anxiety and trait emotional
intelligence and social support.

Conclusions

Patients on hemodialysis suffer from numerous social and psychological problems. Loss of
consciousness and emotional problems increase anxiety and decrease the perception of social
support. These problems may have a negative impact on treatment outcomes.

Keywords
Hemodialysis, chronic renal failure, perceived social support, anxiety

Introduction

Chronic renal disease as a public health problem in the world is very common (Schieppati,
2005). The incidence of end-stage renal failure annual growth of 8%, while the population
growth of 3.1 percent (Schieppati, 2005). Patients with end-stage renal failure need alternative
therapies (Schieppati, 2005). Due to increase in patients with end-stage renal failure is
anticipated that the need for alternative treatments have increased dramatically in the coming
decades (Schieppati, 2005). In 2005, nearly 5.1 million patients with impaired renal replacement
therapy used (Schieppati, 2005). In fact, the number of patients is growing alternative (Cukor,
2008). So that in 2005 it was predicted that in the next decade the number of patients requiring
renal replacement therapy doubles (Schieppati, 2005). Renal replacement therapy, dialysis and
kidney transplantation is the most common chronic hemodialysis (Schieppati, 2005). Almost 15
percent of the world population (one million) is treated with hemodialysis (Schieppati, 2005).
This suggests that the increase in the population of patients undergoing hemodialysis is not our
only problem is a global problem (Schieppati, 2005).

Dialysis patients suffer from multiple symptoms of physical and mental health (Abdel-Kader,
2009). The prevalence of depression in these patients is 10 to 30 percent (Cukor, 2008). Studies
have indicated that the prevalence of anxiety and other mood disorders are more common
(Byers, 2010). So that the level of anxiety in patients with end-stage renal twice normal
individuals and considerably higher than those reported (Cukor, 2008). Anxiety diagnosis in 38%
of patients with end-stage renal failure has been confirmed. poor health outcomes following

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acute attack medication regimen and reduced quality of life, increased hospitalizations and
deaths linked (Byers, 2010) (Cukor, 2008) (GIANG, 2013 (Abdel-Kader, 2009).

Social interactions in chronic patients is important because have benefits to their health
(Callander, 2012). People who participate in social activities are less likely to suffer from mental
disorders (Callander, 2012). Describe the benefits of social support on health is complex and
varied. Reduce Social support lead to increasing chronic disease risk factors such as smoking,
inactivity and health behavior change and maintain (Verheijde, 2005).

As a network of social support from family, friends and neighbors when they need help define
emotional, physical and financial, are available (Chisholm-Burns, 2009). Social support,
emotional support and information tool (Verheijde, 2005). Perceived and received support may
be defined in two ways. Perceived social support refers to a personal understanding of access is
supported support Get Support and refers to a person actually receives (Chisholm-Burns, 2009).

Cognitive and psychosocial aspects of patients undergoing dialysis for two reasons:

1. Population growth in this group of patients

2. Assist in facilitating the use of treatments for enhancing the quality of life (Abdel-Kader,
2009).

However, studies on psychosocial outcomes in patients undergoing hemodialysis, very narrow

and low (Cukor, 2008). According to what was said, the study aims to assess anxiety and
perceived social support, communication between these two components was studied in Patients
on hemodialysis.

Research Methodology

This study is a part of the study was cross-sectional and correlational was performed in 2011 in
the city on patients undergoing hemodialysis. In this study research environment was all
hospitals in the hemodialysis unit.
This research is part of a cross-sectional analytical study in 2011 in Isfahan on patients treated
with hemodialysis. Of all hemodialysis patients formed the study society. For sampling, initially,
all hospitals in the city who were dialysis unit (hospital Al Zahra Zahra Marzieh, Shariati,
Hojjatiyeh and Khorshid) was selected; Then, all hospitals were numbered and the numbers of
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three randomly chosen. Three hospitals were selected: Marzieh Zahra Hospital, Hojjatiyeh and
the Shariati. After considering the inclusion and exclusion criteria were to be purposive
sampling. All those who were enrolled following conditions: The ability to understand and speak
Persian, willingness to participate in this study, can be self-administered questionnaires or with
the assistance of the researcher, treatment with hemodialysis for two or three times a week for at
least three months after starting treatment with hemodialysis.

The researcher, in order to achieve the subjects, after obtaining written permission from the
School of Nursing and Midwifery Khorasgan Islamic Azad University, dialysis centers have
introduced their own section and then select the three centers, the centers have received
authorization to work. After explaining the study and written informed consent from the patients
at the clinic, and giving them the confidence to keep the information contained in the
questionnaire, were selected as the research sample, a total of 126 patients were enrolled
according to the inclusion and exclusion criteria were present in the samples was performed
within 3 months.

The data collection instruments consisted of demographic factors, personality trait anxiety
inventory - status and perceived social support. Character trait anxiety inventory consists of two
parts of 20 questions. The first part, anxiety and the second part specifies the covert anxiety. For
each of the statements in this case, based on the answers provided is allocated a score between
one and four and total scores of both state and trait anxiety scale in the range of 20 to 80 are
placed. After totaling the points earned mild anxiety subjects in the three groups (20 to 39),
moderate anxiety (40 to 59) and severe anxiety (60 to 80) were classified. Reliability and validity
of personality trait anxiety inventory - inside and outside the country, with a correlation
coefficient (r = 0.93) and (r = 0.89) is confirmed (Nazemianpour et al., 2008).

Perceived Social Support Questionnaire, by arbitration and lights (2011) in a study entitled
"Design and the introduction of a specific tool for the study of perceived social support" has been
prepared. The questionnaire consists of three dimensions of social support, emotional support
(questions 1 to 12), and dimension information (questions 13 to 20) and dimension means
(questions 21 and 30). 4-point Likert scale based on the questions asked, no time (Score: 1) to
always (Score 4) graded. The score is in the range of 30 to 120. Score of perceived social support
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in three groups (low, medium and high) were classified; In this case, the numbers between 30
and 59 as low perceived social support, perceived social support, 60 to 89 90 to 120 middle and
high perceived social support was considered. The validity and reliability of the correlation
coefficient (r = 0.895) and Cronbach's alpha (87%) have been approved.

It is noted that the questionnaire by the subjects themselves or a colleague of sufficient

information on the methods and aims of the study had been completed. Data using descriptive
and inferential statistical analysis was performed using SPSS software.

Findings

The average age of the participants in this study was 53.11 14.51 and the majority of
participants were male (60.3 percent). In addition, more than half of the subjects were illiterate or
educated at primary level (56.3 percent), respectively59.5% of the subjects with low family
income, average 32.5 percent and 18 percent of low-income families reported.

The results showed that the majority of those surveyed (68.3) of the support was good. 13.5%
(17 cases) and 18.2 percent (23) of the subjects had a low level of perceived social support.
Different levels of social protection in Table (1) are shown. Average dimensions of social
support, respectively emotional 54.45, dimension 55.05, information, and dimension tools were
40.02. Based on the above results, the subjects of instrumental support were lower than in other
dimensions.

The results showed that 65% and 67.5% of the participants had been suffering from a moderate
level of state and trait anxiety (Table 2).

Spearman correlation coefficients showed that the level of covert and overt anxiety levels of
perceived social support and emotional dimensions and inversely related information. no
significant relationship with instrument seen. Anxiety is the most emotional relationship with
social support. While covert anxiety is the strongest relationships with social support in the
dimension information (Table 3).

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Discussion

The result of the present study was to investigate the relationship between perceived social
supports in patients with end-stage renal anxiety reported. In this study, more than half of
patients (59.5 percent) reported that they have a low income. One of the complications of chronic
diseases is that cause people to retire early. Unemployed individuals to reduce their income
sources (Callander, 2012) (Klari}, 2009). By reducing the sources of income, people change their
lifestyle and habits (Klari}, 2009).

The results showed that the majority of subjects (68.3 percent) had a moderate level of social
protection. The important thing is that the family and social networks in a critical condition
occurs when you provide more social support, but it is not in the process of chronic diseases
(Cornwell1, 2012). Furthermore, Patients on hemodialysis with subjective perception of the
situation could have a negative impact on the social role (Klari}, 2009). This reduces the
perception of social support. Reduce frustration and feelings of loneliness and social support is
directly related to the feeling of wellbeing. It should be remembered that hope and a sense of
well-being is important to continue treatment (Pehlivan, 2012). On the other hand, according to
the results of previous studies of social support on mortality in patients undergoing hemodialysis
is effective (MSY Thong et al., 2007). Given that social support plays an important role in
adaptation to chronic diseases (Cukor, 2007) In this group of patients must be taken to increase
the level of social protection and due to the increased level of compliance with the conditions
and requirements, in addition, mortality and morbidity in patients with chronic renal failure and
hemodialysis down.

According to the results, the subjects of instrumental support were lower than in the other
dimension (average 40.02). In previous studies it has been found that emotional support and
information on the diagnosis and treatment of chronic diseases important role and has great
(Cornwell1, 2012). So that patients who had more emotional support, they are less likely to be
diagnosed hypertension (Cornwell1, 2012). It is worth noting that one of the major risk factors
for kidney disease, high blood pressure. It should be noted that more men than women seek
support tools, while women tend to get emotional support (Dawn, 1999). According to the study,

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the majority of participants were male; most of them are looking for a tool support but have not
understood this aspect of social protection.

The results revealed that more than half of the participants had been suffering from a moderate
level of state and trait anxiety. Based on the results Cukor and et al (2008), hemodialysis patients
are suffering from anxiety and depression. Hemodialysis patients anxiety levels than patients
with other chronic diseases suffer (Klari}, 2009). Zahiroddin and colleagues (2000) found a
direct link between dialysis and anxiety. So, cause anxiety in dialysis patients. The study
Nazemianpour et al (2008), more than half of the participants suffered from moderate levels of
trait anxiety. Scientists believe that in addition to the presence of edema and changes in tissue
integrity, vascular access devices and changes in living conditions, affect the patient's confidence
and can lead to depression and anxiety (Zahiroddin and colleagues (2000), (Klari}, 2009).). Of
course it's important to pay attention to serious problems in patients with depression and anxiety
caused. These problems not only affect the psychological situation of the family; But also on
quality of life, the rate of suicide attempts and suicide, to prolong the lifetime of the patient's
hospitalization and even influence (Melikian et al., 2007) Cukor and et al (2008). The loss of
funds has increased anxiety about the future in these patients (Klari}, 2009).

Statistical tests showed that trait anxiety level is inversely related to the level of perceived social
support (r = -0.229, r = -0.340). Trait anxiety associated with social features (Kohli).).
Researchers believe that the perception of social support in reducing the economic problems of
unemployment, low income, loss of job security and cost effective treatment. Further
improvement in the social network can reduce depression and anxiety, and satisfaction with the
health and reduce the anxiety (Rambod and rafiei, 2009). In addition to providing emotional
support and coping with stress play an important role in enhancing the performance and
improves mental and physical health (Cukor, 2007). Nissi et al (2005) suggest that social support
as a moderator in anxiety disorders and depression plays and there is a negative relationship
between social support and depression and anxiety. Given that social support is a subjective
sense of belonging, acceptance and love being defined, support for each individual a secure and
reassuring connection to create a sense of intimacy of the main features. Social protection and
mutual aid that creates a positive impression accept yourself and feel the love and esteem. All
this gives an opportunity for self-actualization and growth. So if someone from social anxiety
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and social support have largely abated. Because of the support he acts as a protective shield. On
the other hand, the lack of support and lack of social support in the light of a secure connection is
created, positive perception of one and thereby reduce the incidence of anxiety about Nissi et al
(1384). The effects of social support and religion, as a way to cope with anxiety suggests that
higher levels of social support are associated with lower levels of anxiety the most significant
impact of religion, social support has been made in reducing anxiety through the mediating role
of social support. Riahi et al (2010) suggest that social support is strongest and most consistent
predictor of mental health.

The remarkable thing is that patients undergoing hemodialysis who suffer from mental health
problems effect on their perceptions of social support (Cukor, *, 2007). Dimensions of emotional
intelligence and social support is inversely related to anxiety (P <0.05). Instrumental social
support has not a significant relationship with anxiety (P> 0.05). Patients on hemodialysis with
lower education levels, higher levels of overt anxiety suffered (Klari}, 2009). Anxiety is the most
emotional relationship with social support (r = -0.364). Lack of emotional support, most of the
other aspects of social support is more prone to anxiety. The relationship between covert anxiety
and social support in the dimension information (r = -0.402). Without the protection of the
person is prone to covert anxiety. Therefore, to reduce covert anxiety and precise information
should be provided to patients. On the other hand, we can say that the lack of knowledge about
the future of this group of patients is increased covert anxiety.

Conclusions

Due to the effects of stress and social support on chronic patients, especially patients, it is
suggested that future studies focus on the psychosocial treatment of Patients on hemodialysis
performed. In addition, it is recommended that future studies of the relationship between anxiety
and negative health outcomes in this group of patients examined.

Acknowledgement
This research project is approved by the Khorasgan Islamic Azad University. All of these costs
are paid by the Khorasgan Islamic Azad University. Researchers expressed their appreciation
and thanks hemodialysis patients who participated in this study and the authorities respected
hospitals Zahra Marzieh-Hojjatiyeh and Shariati

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Tables:

Table 1: Distribution of the social protection of the population studied

High Average Low Level
Dimensions of social
Percent Abundance Percent Abundance Percent Abundance
support
29/4 37 56/3 71 14/3 18 Emotional dimensions

26/2 33 46/3 81 9/5 12 Dimension Data

9/5 12 59/5 75 31 39
Dimensions tool

Table 2: Distribution of state and trait anxiety levels in the subjects

sum total Severe Average Slight
126 20 82 24 Abundance Level of
100 16 65 19 Percent anxiety

126 18 85 23 Abundance Level of

100 14/3 67/5 18/3 Percent anxiety

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Table 3: the correlation between the level of state and trait anxiety levels of perceived
social support and its dimensions
Dimensions of perceived
Level of anxiety Level of anxiety
social support
Correlation Correlation
P- Value P- Value
coefficient coefficient
0/001 -0/340 0/01 -./229 Total support
0/001 -0/375 000 -./364 Emotional dimensions
0/001 -0/402 0/002 -./271 Dimension Data
0/066 -0/162 0/196 -./006 Dimensions tool

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