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The Relationship of Expressed Emotion And THE RELATIONSHIP OF EXPRESSED EMOTION AND PSYCHOSOCIAL VARIABLES WITH THE QUALITY OF LIFE OF HAEMODIALYSIS PATIENTS : AN ANALYSIS WITHIN THE CONSERVATION OF RESOURCES MODEL A THESIS SUBMITTED TO THE GRADUATE SCHOOL OF SOCIAL SCIENCES OF MIDDLE EAST TECHINICAL UNIVERSITY BY ÖZDEN YALÇINKAYA ALKAR IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE DEPARTMENT OF PSYCHOLOGY JUNE 2006 Approval of the Graduate School of Social Sciences Prof. Dr. Sencer Ayata Director I certify that this thesis satisfies all the requirements as a thesis for the degree of Doctor of Philosophy. Prof. Dr. Nebi Sümer Head of Department This is to certify that we have read this thesis and that in our opinion it is fully adequate, in scope and quality, as a thesis for the degree of Doctor of Philosophy. Prof. Dr. A. Nuray Karancı Supervisor Examining Committee Members Prof. Dr. A. Nuray Karancı (METU, PSY) Doç. Dr. Tülin Gençöz (METU, PSY) Doç. Dr. Gonca Soygüt (HÜ, PSY) Doç. Dr. Atilla Soykan (AÜ, PSYCHIATRY) Dr. Özlem Bozo (METU, PSY) I hereby declare that all information in this document has been obtained and presented in accordance with academic rules and ethical conduct. I also declare that, as required by these rules and conduct, I have fully cited and referenced all material and results that are not original to this work. Name, Last name : Özden Yalçınkaya Alkar Signature : iii ABSTRACT QUALITY OF LIFE OF HAEMODIALYSIS PATIENTS AND RELATIONSHIP TO EXPRESSED EMOTION AND PSYCHOSOCIAL VARIABLES: AN ANALYSIS WITHIN THE CONSERVATION OF RESOURCES MODEL Yalçınkaya Alkar, Özden Ph.D., Department of Psychology Supervisor : Prof. Dr. A. Nuray Karancı June 2006, 219 pages This study aimed to examine the quality of life (QOL) and well-being of haemodialysis patients and the relationship of two components of perceived expressed emotion (criticism/hostility and emotional over-involvement) and other psychosocial resources within the Conservation of Resources Model. Demographic variables and haemodialysis related information of patients, classified as resources, were also included in the study. One hundred and six haemodialysis patients voluntarily participated in the study. Before the main study, for evaluating the psychometric properties of the Symptom Distress Scale (SDS), Coping Self-Efficacy Scale (CSES), and Perceived Expressed Emotion Scale (PEES) a pilot study was iv conducted with the fifty-three haemodialysis patients. Results of the pilot study provided support for the reliability and validity of scales. For the main study, optimism, self-esteem, and perceived social support were taken as resources and were also included as measures. In order to test the main hypothesis of the studies a series of regression analyses were conducted. The results of the analysis revealed that predictors of well-being were age, self esteem, criticism/hostility factor of perceived expressed emotion and coping self-efficacy; predictors of physical health component of QOL were age, education, presence of additional diagnosis, and coping self-efficacy. Moreover, it was found that predictors of mental health component of QOL were the presence of additional diagnosis and coping self- efficacy; and predictors of the mean score of QOL were age, presence of additional diagnosis, self-esteem, and coping self-efficacy. Directions of the relationship between age, education, presence of additional diagnosis, and criticism/hostility were negative with the outcome variables, whereas, directions of the relationship between self-esteem and coping self-efficacy were positive with the outcome variables. The mediational role of coping self-efficacy in the association between resources and outcome variables were also investigated. Mediator effect of coping self-efficacy was found only for two variables. Firstly, the effect of duration of haemodialysis treatment was mediated by the coping self-efficacy for the well being measure. Second, coping self-efficacy carries the influence of the family income to the mean score of QOL. After discussing the findings of the present study in the light of the literature, the limitations and the clinical implications of the results and directions for the future studies were suggested. v Keywords: Conservation of Resources Model, Quality of Life, Expressed Emotion, Well-being, Haemodialysis, Coping Self-efficacy, Symptom Distress, Optimism, Self esteem, Social Support. vi ÖZ HEMODİYALİZ HASTALARININ YAŞAM KALİTELERİ VE DIŞA VURAN DUYGULARLA VE PSİKOSOSYAL DEĞİŞKENLERLE İLİŞKİSİ: KAYNAKLARIN KORUNMASI MODELİ ÇERÇEVESİNDE BİR DEĞERLENDİRME Yalçınkaya Alkar, Özden Doktora, Psikoloji Bölümü Tez Yöneticisi: Prof. Dr. A. Nuray Karancı Haziran 2006, 219 sayfa Bu çalışmada hemodiyaliz hastalarının yaşam kalitesi ve psikolojik iyilik halleri ile, dışa vuran duygu durumunun iki faktörü (eleştirici/düşmanca tutum ve duygusal aşırı bağlanma faktörü) ve diğer psikososyal değişkenler arasındaki ilişki, Kaynakların Korunumu Modeli çerçevesinde araştırıldı. Kaynak olarak sınıflandırılan, demografik değişkenler ve hastaların hemodiyalizle ilgili bilgileri araştırmaya dahil edildi. Çalışmaya 106 gönüllü diyaliz hastası katılmıştır. Ana çalışmadan önce, Semptom Sıkıntı Ölçeğinin (SDS), Başetme Özyeterlilik Ölçeğinin (CSES) ve Algılanan Dışavuran Duygudurum Ölçeğinin (PEES) psikometrik vii özelliklerini değerlendirmek amacıyla, 53 hastanın katıldığı, bir pilot çalışma gerçekleştirilmiştir. Pilot çalışmanın sonucu, ölçeklerin geçerlilik ve güvenilirliklerinin kabul edilebilir düzeyde olduğunu desteklemiştir. Ana çalışmaya, kaynak olarak kabul edilen, iyimserlik, benlik saygısı, ve algılanan sosyal desteğin ölçümleri de eklenmiştir. Araştırmanın temel hipotezlerini test etmek için regresyon analizleri kullanılmıştır. Bulgular, psikolojik iyilik durumunu, yaş, benlik saygısı, dışa vuran duygu durumunun eleştirici/düşmanca tutum faktörü ve başetme özyeterliliği değişkenlerinin; yaşam kalitesi ölçeğinin fiziksel sağlık bileşeni ise, yaş, eğitim, ikinci bir kronik hastalığın varlığı, ve başetme özyeterliliği değişkenlerinin yordadığını göstermiştir. Ayrıca, yaşam kalitesinin ruhsal sağlık bileşenini, ikinci bir kronik hastalığın varlığı, ve başetme özyeterliliği değişkenleri; yaşam kalitesi ölçeğinin ortalamasını ise, yaş, ikinci bir kronik hastalığın varlığı, benlik saygısı, ve başetme özyeterliliği değişkenleri yordamıştır. Yaş, eğitim, ikinci bir kronik hastalığın varlığı, eleştirici/düşmanca tutum değişkenleri sonuç değişkenleri ile negatif yönde ilişki gösterirken, benlik saygısı ve başetme özyeterliliği değişkenleri sonuç değişkenleri ile pozitif yönde ilişki göstermiştir. Başetme özyeterliliği değişkeninin kaynaklar ve yaşam kalitesi ve psikolojik iyilik hali değişkenleri arasındaki ilişkideki aracılık rolü de araştırılmıştır. Başetme özyeterliliği değişkeninin aracılık etkisi iki değişken için bulunmuştur. İlk olarak, hemodiyaliz tedavisi süresinin, psikolojik iyilik hali üzerine etkisine, başetme özyeterliliği aracılık etmiştir. İkinci olarak, başetme özyeterliliği, ailenin gelirinin etkisini, yaşam kalitesi ölçeğinin ortalaması değişkeni üzerine taşımıştır. Araştırmanın bulguları viii literatür ışığında tartışıldıktan sonra, araştırmanın sınırlılıkları ve implikasyonları ve gelecekteki çalışmalar için önerilere yer verilmiştir. Anahtar Kelimeler: Kaynakların Korunumu Modeli, Yaşam Kalitesi, Dışavuran Duygudurum, Psikolojik İyilik, Hemodiyaliz, Başaçıkma Özyeterliliği, Semptom Sıkıntısı, İyimserlik, Benlik Saygısı, Sosyal Destek. ix ACKNOWLEDGMENTS The author wishes to express his deepest gratitude to his supervisor Prof. Dr. A. Nuray Karancı for her guidance, advice, criticism, encouragements and insight throughout the research. The author would also like to thank Assoc. Prof. Dr. Tülin Gençöz, Assoc. Prof. Dr. Gonca Soygüt, Assoc. Prof. Dr. Atilla Soykan and Dr. Özlem Bozo for their wisdom, valuable input, constuctive remarks and support. The author would like to thank to her dear husband, Ali Ziya for his love, encouregement, never ending patience, support and compassion all through the PhD and for being very understanding and belief for staying and finishing PhD education. Finally, author was grateful to her family, for their supports. x TABLE OF CONTENTS PLAGIARISM...................................................................................................... iii ABSTRACT.......................................................................................................... iv ÖZ.................................................................................................……………… vii ACKNOWLEDGMENTS.................................................................................... x TABLE OF CONTENTS..............................................................................…... xi CHAPTER 1. INTRODUCTION...........................................................................…... 1 1.1 End Stage Renal Disease: Effects and Treatment ……………….. 2 1.1.1 Effects of haemodialysis………………………...…………. 5 1.2 Theoretical Framework of the Study: Conservation of Resources Theory……………………………………………… 7 1.2.1 Conservation of Resources Theory as It Related to Haemodialysis……………………………………….……. 10 1.3 Social Resources…………………………………………………. 14 1.3.1 Expressed Emotion………………………………………… 14 xi 1.3.1.1 Expressed Emotion and Psychiatric Illness………….. 16 1.3.1.2 Expressed Emotion and Medical Illness…………….. 18 1.3.1.3 Expressed Emotion and Haemodialysis Patients…… 19 1.3.1.4 Perceived Expressed Emotion of Patients…………… 21 1.3.2 Social Support……………………………………………….
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