Relação entre estresse e padrões de “coping” e aderência medicamentosa no transplante renal

Abstract

Chronic Renal Failure is a serious public health problem. The available treatments are not curative, but rather substitutes and renal transplantation is the modality that brings better quality of life and longer survival. Adherence to immunosuppressant therapy constitutes a fundamental issue for the results of transplantation. Adherence can be defined as the degree of agreement between the patient's behavior and the health professionals’ recommendations. It is influenced by many factors, including those related to the patient's behaviors that are very poorly studied. Stress and coping patterns are part of this group. It is believed that the transplantation, even being the best therapeutic option, results in different kinds of stress to the patient. The term coping is used to identify the cognitive and behavioral responses issued by the individual to deal with the situation precipitating stress, aiming to reduce, mitigate or avoid it. Effective responses result a positive adjustment to stress, minimizing the impact of the mental and physical health of the patient. Intreventions on the most stressful situations and on coping patterns may contribute to the maintenance of general mental health of transplant recipients, leading consequently to an appropriate process of adherence to immunosuppressive treatment. This study aimed to evaluate the relationship between stress and the types of stress coping responses, with adherence to immunosuppressive treatment after the kidney transplantation. We also identified the benefits/challenges perceived by transplant patients and sociodemographic/clinical data associated with stress. We conducted a cross-sectional case-control study, involving 25 previously classified as adherent and 25 non adherent transplant patients, treated as outpatients from Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia. As inclusion criteria, were considered a minimum age of 18 years and have more than one year of functioning graft. The degree of adherence to treatment was measured by adapted and validated instrument The Basel Assessment of Adherence with Immunosuppressive Medication Scale. The stress and stress coping response were assessed by the Lipp Stress Symptom Inventory for Adults and the Ways of Coping Scale, respectively. A semi structured interview was conducted in order to detect major stressful events related to the transplantation. Frequency analysis was used to evaluate the qualitative and categories variables. T Test, Mann-Whitney, Chi-square or Fisher's Test and logistic regression were used to compare adherent and nonadherent groups. Differences are considered significant when p ≤ 0.05. The mean age of our population was 44 ± 12.8ys and the median of post-transplant time was 71.8 (12-230) months. Stress was prevalent in 50%. The categories of “Fear” and “Medication” were the most stressful concerns. Non-adherence was significantly associated with more advanced stress phases (OR 4.7, IC: 0.99-22.51, p < 0.05) and palliative coping (OR 3.4, IC: 1.02-11.47, p < 0.05). The stress was significantly associated with female gender (p = 0.04), presence of comorbidities (p = 0.04) and responses not directed to problem solving coping (p < 0.0001). We conclude that the presence of stress and the non active coping patterns are associated with non adherence of immunosuppressive after renal transplantation. These results highlight the psychological events have implications for the understanding and management of non-adherent transplant patients.