Psychological and social problems of dialysis.

Abstract

patients and physicians were allies in a continual fight Dr Vaccaro: First of all, thank you for inviting me to for survival, emotional problems were suppressed. As this Round Table on the psycho-social problems of technical and medical improvements in dialysis techdialysis, and above all for this opportunity to outline niques resulted in healthier patients and the threat of to such illustrious experts in this field the results of a death faded into the background, emotional rather study conducted recently by CENSIS [1], which I was than methodological problems would become dominhonoured to supervise, focusing on the quality of life ant, and the suicide rate would rise. of chronic nephropathic patients undergoing dialysis. As a matter of fact, in 1971 the first paper appeared This aspect appears to be rather neglected by most (Abram and collegues) on spontaneous withdrawal studies on the subject of dialysis. from dialysis, and in the same year the first paper on When analysing the quality of life, the first problem suicide on dialysis was published. Suicide on dialysis is to select correct criteria for its measurement. Social was reported to be 50 time more frequent than in the research methodology offers a number of solutions in general population, but this was probably a simple this respect. As far as our study was concerned, we estimate as the suicide rate in the general population followed the approach typical of a social research is probably greater than the reported 10 per 100 000 institute, choosing to give a central role to the patient’s people. Nevertheless, the suicide rate in patients on self-appraisal and considering his/her point of view as dialysis is many times higher than in the general a vital and fundamental element for the assessment of population and probably is much higher than in any ‘quality of life’ viewed subjectively. other chronic disabling illness. A number of psycho-social variables associated with It is evident that we encounter social and psycholothe illness were then considered, believed to be of gical problems about which we are not so well versed. strategic importance in understanding the patient’s To tell the truth, doctors are so engaged in clinical opinion about his own quality of life. The personal activity that they seldom see things from the patient’s appraisal of the patient regarding his/her condition point of view. When a patient discovers he has got was analysed in relation to structural (type of treatchronic kidney failure needing artificial substitution, ment, socio-demographic condition, general state of he receives a tremendous shock, one which probably health) and psychological variables (psychological will affect his whole life. According to Norman Levy, well-being, self-esteem). In particular, the following an American psychiatrist dealing with these problems, dimensions were taken into consideration: family and from the moment that substitution therapy starts there working situation, relationships of family and friends,