Shame and disgust-sensitivity in adult dialysis patients : are these variables predictive of psychological morbidity, body image disturbance and quality of life?

Section one: Literature Review - Previous reviews have focussed on psychosocial adjustment, with an assumption that psychological morbidity is present in patients with a stoma. A single review of psychological morbidity was identified with significant limitations in reporting the search process (White & Hunt, 1997). Search criteria were systematically applied to electronic databases. After consideration of inclusion and exclusion criteria, 11 relevant studies were identified. Findings indicated psychological morbidity is present, although has not been compared to the general population so conclusions must be interpreted with caution. Psychological morbidity was not a primary focus of the studies and the psychometric adequacy of the measures used has been drawn into question. Further research clarifying the nature of psychological morbidity compared with other populations is recommended, so as to provide targeted psychological support. Section two: Research Report - Renal replacement therapies are not without personal cost. Psychological morbidity, diminished quality of life and body image disturbance are reported in dialysis patients, yet predictors of these are relatively understudied. This study aimed to measure shame and disgust in dialysis patients, and consider association with psychological difficulties. The study employed a cross-sectional survey design. Questionnaires were sent to dialysis patients via routine appointments and by post, with 93 returned. Data were examined using correlation and multiple regression analyses. Participants demonstrated significantly higher levels of psychological difficulties than the general population. General shame and disgust-sensitivity were not significantly elevated, however specific measures of body shame and disgust accounted for 18-61% of variance in psychological difficulties. Body shame and disgust were advanced as a marker of psychological difficulty in this population. Further research is necessary to develop the measure used, to facilitate a clinical tool to support professionals in recognising and managing psychological distress. Section three: Critical Appraisal - Reflections on the research process are summarised and critically appraised.