Title

Children's Coping with Chronic Kidney Disease and Concurrent Adjustment

Date of Award

2011

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Psychology/Clinical

First Advisor

Eric Dubow, Ph.D

Second Advisor

Kenneth Pargament, Ph.D. (Committee Member)

Third Advisor

Dara Musher-Eizenman, Ph.D (Committee Member)

Fourth Advisor

Jacquelyn Cuneen, Ed.D (Committee Member)

Abstract

Children’s coping with, and adjustment to, chronic kidney disease was investigated. Twenty-eight children (14 pre-kidney transplant and 14 post-kidney transplant patients) and their parents participated in the study. Children identified a specific disease-related stressor that was distressing to them and reported on the coping strategies they used to deal with that stressor. Children also completed a measure of perceived parental support for coping, which assessed the types of coping strategies that children perceive their parents to be encouraging them to use, and their parents completed a parallel measure of coping strategies they encourage their child to use. are supporting the use of in their child). Finally, children completed measures of their adjustment (i.e., health-related quality of life, anxiety symptoms, depressive symptoms) and their parents completed a brief index of their child’s global adjustment. Three hypotheses were examined: 1) Children will use more secondary control engagement coping strategies (e.g., distraction, positive thinking, cognitive restructuring, humor, acceptance) than either primary control engagement strategies (e.g., problem solving, emotion regulation, emotional expression) or disengagement strategies (e.g., avoidance, denial, wishful thinking) and they will use more primary control engagement strategies than disengagement strategies; parental support for coping strategies will follow similar patterns; 2) Children who use higher levels of secondary control engagement coping and primary control engagement coping will exhibit better adjustment, whereas children who use disengagement coping will exhibit poorer adjustment; and 3) Parental support for primary and secondary control strategies will moderate the relation between children’s disengagement coping and negative adjustment.

Preliminary analyses showed that children in the pre-transplant versus post-transplant phase of treatment did not use different coping strategies and no differences were found between the two groups in terms of their adjustment. In terms of hypothesis 1, children with chronic kidney disease most often used secondary control engagement coping, followed by positive religious coping and primary control engagement coping, to deal with their disease-related stressors. Children perceived higher levels of parental support for secondary control engagement coping, followed by primary control engagement coping, and positive religious coping. Parents reported that they provide the most support for primary control engagement coping. Disengagement and negative religious coping were least frequently used by children and were least likely to be encouraged by parents. This pattern of results generally supports hypothesis 1.

Regarding hypothesis 2, children’s use of disengagement coping was found to be related to negative outcomes, particularly depression and general health-related quality of life. However, parent-reported coping support did not relate to children’s adjustment. These results provided partial support for hypothesis 2. Finally, in terms of hypothesis 3, perceived parental support for secondary control engagement coping strategies moderated the relation between children’s use of disengagement coping and some measure of negative adjustment. Specifically, when children were using high level of disengagement coping and perceiving high level of parental support for secondary control engagement coping, they had fewer depressive symptoms than children who were using high levels of disengagement and perceived low levels of parental support for secondary control engagement coping. A similar effect was found for ESRD health-related quality of life, children who used higher levels of disengagement and perceived high levels of parental support for secondary control engagement coping has better ESRD health-related qua...