Annals of Behavioral Medicine

, Volume 21, Issue 4, pp 311–316 | Cite as

Family environment, intrusive ideation, and adjustment among renal transplant candidates

  • Patricia J. Moran
  • Alan J. Christensen
  • Shawna L. Ehlers
  • J. Andrew Bertolatus
Empirical Articles


Waiting for an organ transplant is a stressful experience frequently associated with symptoms of depression and anxiety. Little empirical work has examined patients during the stressful period prior to transplantation, particularly among patients waiting for a renal transplant. A large body of research has demonstrated that social and family support variables are associated with psychological adjustment in a variety of medical populations. Little research has examined the mechanism by which social support exerts its effects on psychological well-being. We examined two possible models of the role of intrusive thoughts on the relationship between a supportive family environment and both depression and anxiety in a sample of 75 patients with end-stage renal disease (ESRD) waiting for a kidney transplant. Path analyses provided modest support for a mediational model, showing that intrusive thoughts partly accounted for the relationship between family expressiveness and psychological distress. A moderational model examining the interactive effects of family environment and intrusive thinking on adjustment was not supported.


Behavioral Medicine Family Environment Psychological Adjustment ESRD Patient Intrusive Thought 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. (1).
    Kuhn WF, Davis MH, Lippman SB: Emotional adjustment to cardiac transplantation.General Hospital Psychiatry. 1988,10:108–113.PubMedCrossRefGoogle Scholar
  2. (2).
    Levenson JL, Olbrisch ME: Shortage of donor organs and long waits.Psychosomatics. 1987,28:399–403.PubMedGoogle Scholar
  3. (3).
    Sensky T: Psychosomatic aspects of end-stage renal failure.Psychotherapy and Psychosomatics. 1993,59:56–58.PubMedCrossRefGoogle Scholar
  4. (4).
    Greene AF, Sears SF: Psychometric assessment of cardiac transplantation candidates.Journal of Clinical Psychology in Medical Settings. 1994,1(2):135–147.CrossRefGoogle Scholar
  5. (5).
    Kugler J, Tenderich G, Stahlut P, et al: Emotional adjustment and perceived locus of control in heart transplant recipients.Journal of Psychosomatic Research. 1994,38:403–408.PubMedCrossRefGoogle Scholar
  6. (6).
    Christensen AJ, Holman JM, Turner CW, et al: A prospective study of quality of life in end-stage renal disease: Effects of cadaveric renal transplantation.Clinical Transplantation. 1991,5:40–47.Google Scholar
  7. (7).
    Sensky T: Psychiatric morbidity in renal transplantation.Psychotherapy and Psychosomatics. 1989,52:41–46.PubMedGoogle Scholar
  8. (8).
    Cohen S, Wills TA: Stress, social support, and the buffering hypothesis.Psychological Bulletin. 1985,98:310–357.PubMedCrossRefGoogle Scholar
  9. (9).
    Wortman CB, Conway TL: The role of social support in adaptation and recovery from physical illness. In Cohen S, Syme SL (eds),Social Support and Health. New York: Academic Press, 281–302.Google Scholar
  10. (10).
    Christensen AJ, Moran PJ: Psychosomatic research in end-stage renal disease: A framework for matching patient to treatment.Journal of Psychosomatic Research. 1998,44:523–528.PubMedCrossRefGoogle Scholar
  11. (11).
    Christensen AJ, Turner CW, Slaughter JR, Holman JM: Perceived family support as a moderator of psychological well-being in end-stage renal disease.Journal of Behavioral Medicine. 1998,12:249–265.CrossRefGoogle Scholar
  12. (12).
    Moos RH, Moos BS:Family Environment Scale Manual (2nd Ed.). Palo Alto, CA: Consulting Psychologists Press, 1986.Google Scholar
  13. (13).
    Burton HJ, Lindsay RM, Kline SA: Social support as a mediator of psychological dysfunction and a determinant of renal failure outcomes.Clinical and Experimental Dialysis. 1983,7(4):371–389.Google Scholar
  14. (14).
    Siegal BR, Calsyn RJ, Cuddihee RM: The relationship of social support to psychological adjustment in end-stage renal disease patients.Journal of Chronic Disease. 1987,40:337–344.CrossRefGoogle Scholar
  15. (15).
    Christensen AJ, Smith TW, Turner CW, et al: Family support, physical impairment, and adherence in hemodialysis: An investigation of main and buffering effects.Journal of Behavioral Medicine. 1992,15:313–325.PubMedCrossRefGoogle Scholar
  16. (16).
    Christensen AJ, Wiebe JS, Smith TW, Turner CW: Predictors of survival among hemodialysis patients: Effect of perceived family support.Health Psychology. 1994,13:521–525.PubMedCrossRefGoogle Scholar
  17. (17).
    Dimond M: Social support and adaptation to chronic illness: The case of maintenance hemodialysis.Research in Nursing and Health. 1979,2:101–108.PubMedCrossRefGoogle Scholar
  18. (18).
    Barrera M: Distinctions between social support concepts, measures, and models.American Journal of Community Psychology. 1986,14:413–445.CrossRefGoogle Scholar
  19. (19).
    Druley JA, Townsend AL: Self-esteem as a mediator between spousal support and depressive symptoms: A comparison of healthy individuals and individuals coping with arthritis.Health Psychology. 1998,17:255–261.PubMedCrossRefGoogle Scholar
  20. (20).
    Duncan TE, McAuley E: Social support and efficacy cognitions in exercise adherence: A latent growth curve analysis.Journal of Behavioral Medicine. 1993,16:199–218.PubMedCrossRefGoogle Scholar
  21. (21).
    Horowitz MK: Stress response syndromes and their treatment. In Goldberger L, Breznitz S (eds),Handbook of Stress: Theoretical and Clinical Aspects. New York: Free Press, 1982, 711–732.Google Scholar
  22. (22).
    Baum A: Stress, intrusive imagery, and chronic distress.Health Psychology. 1990,9:653–675.PubMedCrossRefGoogle Scholar
  23. (23).
    Baider L, De-Nour AK: Psychological distress and intrusive thoughts in cancer patients.Journal of Nervous and Mental Disease. 1997,185:346–348.PubMedCrossRefGoogle Scholar
  24. (24).
    Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology. 1986,51:1173–1182.PubMedCrossRefGoogle Scholar
  25. (25).
    Lepore SJ, Silver RC, Wortman CB, Wayment HA: Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers.Journal of Personality and Social Psychology. 1996,70:271–282.PubMedCrossRefGoogle Scholar
  26. (26).
    Lepore SJ, Helgeson VS: Social constraints, intrusive thoughts, and mental health after prostate cancer.Journal of Social and Clinical Psychology. 1998,17:89–106.Google Scholar
  27. (27).
    United States Renal Data System:USRDS 1998 Annual Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes, Digestive, and Kidney Diseases, 1998.Google Scholar
  28. (28).
    United Network of Organ Sharing:1997 Annual Report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network—Transplant Data: 1988–1996. Richmond, VA and Rockville, MD: UNOS and the Division of Transplantation, Office of Special Programs, Health Resources and Services Administration, U.S. Department of Health and Human Services, 1997.Google Scholar
  29. (29).
    Holahan CJ, Moos RH: The quality of social support: Measures of family and work relationships.British Journal of Clinical Psychology. 1983,22:157–162.Google Scholar
  30. (30).
    Horowitz M, Wilner N, Alvarez W: Impact of events scale: A measure of subjective stress.Psychosomatic Medicine. 1979,41:209–218.PubMedGoogle Scholar
  31. (31).
    Zilberg N, Weiss D, Horowitz M: Impact of event scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes.Journal of Consulting and Clinical Psychology. 1982,50:407–414.PubMedCrossRefGoogle Scholar
  32. (32).
    Beck A, Ward C, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression.Archives of General Psychiatry. 1961,4:561–571.PubMedGoogle Scholar
  33. (33).
    Beck A, Steer R, Garbin M: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.Clinical Psychology Review. 1988,8:77–100.CrossRefGoogle Scholar
  34. (34).
    Spielberger CD, Gorsuch RL, Lushene RE:Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press, 1970.Google Scholar
  35. (35).
    Schaefer C, Coyne JC, Lazarus RS: The health-related functions of social support.Journal of Behavioral Medicine. 1981,4:381–406.PubMedCrossRefGoogle Scholar
  36. (36).
    Wallston BS, Alagna SW, DeVellis BM, DeVellis RF: Social support and physical health.Health Psychology. 1983,2:367–391.CrossRefGoogle Scholar
  37. (37).
    Christensen AJ, Moran PJ, Lawton WJ, Stallman D, Voigts AL: Monitoring attentional style and medical regimen adherence in hemodialysis patients.Health Psychology. 1997,16:256–262.PubMedCrossRefGoogle Scholar
  38. (38).
    Pennebaker JW: Putting stress into words: Health, linguistic, and therapeutic implications.Behaviour Research and Therapy. 1993,31:539–548.PubMedCrossRefGoogle Scholar
  39. (39).
    Clark LF: Stress and the cognitive-conversational benefits of social interaction.Journal of Social and Clinical Psychology. 1993,12:25–55.Google Scholar
  40. (40).
    Coyne JC: Depression and the response of others.Journal of Abnormal Psychology. 1976,85:186–193.PubMedCrossRefGoogle Scholar
  41. (41).
    Joiner TE, Alfano MS, Metalsky GI: When depression breeds contempt: Reassurance seeking, self-esteem, and rejection of depressed college students by their roommates.Journal of Abnormal Psychology. 1992,101:165–173.PubMedCrossRefGoogle Scholar
  42. (42).
    Ironson G, LaPerriere A, Antoni M, et al: Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status.Psychosomatic Medicine. 1990,52:247–270.PubMedGoogle Scholar
  43. (43).
    Spiegel D, Bloom J, Kraemer H, Gottheil E: Effect of psychosocial treatment on survival of patients with metastatic breast cancer.Lancet. 1989,2:888–891.PubMedCrossRefGoogle Scholar
  44. (44).
    Pennebaker JW, Barger SD, Tiebout J: Disclosure of traumas and health among Holocaust survivors.Psychosomatic Medicine. 1989,51:577–589.PubMedGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 1999

Authors and Affiliations

  • Patricia J. Moran
    • 1
  • Alan J. Christensen
    • 1
  • Shawna L. Ehlers
    • 1
  • J. Andrew Bertolatus
    • 1
  1. 1.Department of PsychologyThe University of IowaIowa City

Personalised recommendations