Domestic and international studies have shown that patients with abdominal dialysis are prone to anxiety, depression and other psychological disorders, which seriously affect the quality of life, clinical course of the disease and rehabilitation of patients. In general, patients’ psychological reactions go through the following 6 stages, namely suspicion, anger → anxiety, depression → guilt, loss → pessimism and disappointment, self-pity, loneliness → increased dependence, enhanced self-centeredness → expectation, which is also the process of emotional transformation of patients from the beginning of receiving dialysis to stable dialysis, and the performance varies in severity from patient to patient.
1. Causes of psychological problems in patients on abdominal dialysis
(1) Patients are troubled by chronic renal failure for a long time, and are prone to pessimism because they have not obtained satisfactory results from years of medical treatment.
(2) Patients who have just received peritoneal dialysis treatment are often overly worried about the success or failure of peritoneal dialysis and the possible side effects of dialysis because they do not understand the treatment.
(3) Negative changes in self-image after receiving peritoneal dialysis treatment (such as having dialysis catheters placed in the abdomen, obesity, etc.) and often accompanied by decreased libido, impotence, infertility, etc., tend to produce low self-esteem and paranoia.
(4) With the prolonged duration of abdominal dialysis, due to low self-esteem, they are reluctant to go out all day at home, resulting in reduced social activities, and thus lose interest in many things.
(5) Over-dependence due to physical reasons, and excessive demands on people around them, bring about family disharmony and conflicts, and aggravate patients’ anxiety.
(6) In addition to suffering from the disease, patients are prone to negative emotions due to old age, frailty, impairment in self-care, economic constraints of long-term abdominal dialysis, lack of care by family members, and reduced social support.
(7) The experience of complications of peritoneal dialysis, such as the occurrence of peritonitis, aggravates the feeling of anxiety due to the fear of re-occurrence of complications such as peritonitis.
2, the impact of psychological problems on patients with abdominal dialysis
(1) Increase the incidence of cardiovascular disease and mortality. The mechanism may be related to depression increasing the risk factors for cardiovascular diseases (such as smoking, diabetes, hypertension), increasing platelet aggregation, and promoting microinflammatory responses.
(2) Disturbed immune regulation, decreased immunity to pathogenic bacteria, and increased risk of infection. Some studies have found an association between the development of peritonitis and psychological factors, including depression, anxiety, and family relationships.
(3) Reduced serum albumin (ALB) and malnutrition. This may be related to depression itself causing gastrointestinal symptoms and inadequate dialysis.
(4) Amplified symptoms of physical illness and deficits in somatic social functioning. Due to the weakened psychological regulation of chronic illness, various psychological factors can cause new somatic functional and organic changes.
(5) Poor compliance with treatment, which further aggravates the disease and accelerates its deterioration.
3, psychotherapeutic interventions for patients with abdominal dialysis
(1) Medical and nursing staff
① Establish a good relationship with patients, always treat patients with a sincere attitude, maintain equal status with patients, and pay attention to creating a relaxed conversation environment when communicating with patients to give them a sense of trust and security.
② Take the initiative to communicate with the patient, listen patiently and attentively, make the patient feel valued and cared for, and help the patient clarify the cause of his or her anxiety by looking for specific events that trigger the patient’s emotional problems.
③ Respect the patient’s subjective feelings, protect the patient’s privacy, and avoid causing unnecessary tension. Patience and inspiration should be given to the patient to eliminate psychological pressure and the sense of isolation and helplessness, and encourage the patient to build up confidence.
④ Strengthen health education to make patients correctly understand their condition, the importance and necessity of dialysis treatment, eliminate anxiety and other adverse emotions, and actively and positively cooperate with treatment; improve patients’ self-care ability, reduce dependency, avoid friction due to excessive demands to family members, and reduce the generation of family conflicts. Through regular home visits and the opening of a hotline, patients can get timely solutions to problems they encounter.
(2) Family and society
① Family is an important part of social support, and good family support is a prerequisite and foundation for improving the quality of life. Family support mainly comes from spouses and children. Care, understanding and support from family members can help patients avoid the adverse emotions of isolation, desolation and pessimism and buffer their mental pressure.
② Call on society to pay more attention to abdominal dialysis patients, reduce discrimination, and improve the medical insurance system to reduce economic pressure.
(3) Patients themselves
① Participate in more social activities and strengthen the contact and confidences among patients, which can enable patients to receive mutual emotional support, reduce the pressure caused by the disease, and enable patients to establish an optimistic and confident psychological state.
② Communicate with family members, relatives and friends, and medical personnel when you encounter problems that are difficult to solve or confusing, and contact your doctor for help when you are anxious or depressed, and do not refrain from seeking medical help.