The relationship of referential activity in speech to marital adjustment, psychosocial adjustment and physical health in dialysis patients and their partners

Donna M. Whipple (1994)

Currently 90,000 Americans are being kept alive by dialysis. Dialysis is recognized as an extraordinarily stressful life event in which patients and their partners and families struggle with conflicting fears around death and quality of life. The family, particularly the partner or spouse has been recognized as crucial to both the quality of life and the survival of the dialysis patient. Much of what has been written on the couple adjusting to dialysis has pointed out the prevalence of denial as a coping mechanism in these couples. The present study explored the theoretical notion of denial and presented some problems inherent in using concepts such as denial that are hard to operationalize and that have multiple meanings. The present study examined the notion of the presence of "denial" in couples dealing with dialysis within the frame of contemporary models of mental functioning, specifically Multiple Code Theory, and attempted to show that what is commonly labeled denial in the dialysis population may be several different defensive operations and is a naturally occurring by-product of adjustment that can be measured objectively as referential activity in speech. The present study also examined the relationship between levels of referential activity (RA) in the spoken language of the couple and marital adjustment, psycho-social adjustment to illness and physical health. Forty couples were given four monologues and one dialogue task from which a measure of referential activity were taken for both individuals and the couple overall. The couples were given the Dyadic Adjustment Scale, the Psychosocial Adjustment to Illness Scale and a health rating scale. A request was made for a physician to complete the End Stage Renal Disease Severity Index for each patient. Relationships between levels of referential activity in speech in both couples and individual members of the couple were examined in relationship to marital adjustment, psychosocial adjustment to illness and physical health. Adequate interrater reliability was not attained in the present study and the reasons for this are discussed. Because of this problem, all RA results in the study must be viewed with caution. The results revealed several significant non-RA findings. These included, the finding that while spouses perceive themselves as less well adjusted than patients, spouses and patients show quantitatively similar levels of adjustment. A relationship was found between RA and objective physical health in patients. The findings on relationship measures indicate that both patients and spouses are equally satisfied with their marriages. Additional relationships were found between some RA measures and length of time on dialysis. Implications of the findings are discussed and recommendations to improve future studies are given. Finally, implications for the treatment of this population are discussed, in particular the importance of support groups for dialysis patients and their partners.