| End-Stage Renal Disease (ESRD) is a major illness which impacts physical well-being, family and social relationships, work and finances, and leisure activities. The psychosocial impact is implicated in high rates of depression, non-compliance, and mortality. Clinical intervention must address these sequalae and be based on factors contributing to the transactional process of adaptation to ESRD. All illness has meaning beyond particular physical events; interpretation of which can facilitate adaptation (Kleinman, 1988). A conceptual framework for studying the meaning of illness is provided by the developmental conceptions of illness model (Walsh & Bibace, 1990).;A combined quantitative/qualitative approach, guided by a "partnership model" of research, was utilized to explore the relationship between the meaning of illness and depression and treatment compliance in patients with ESRD. Patients with ESRD and treated with hemodialysis (N = 11) completed the Concepts of Illness Protocol, the Beck Depression Inventory and the General Adherence Scale. Patients were invited to a focus group discussion on their experiences in adapting to ESRD. Staff members (N = 12) also attended a focus group exploring their understanding of adaptation to ESRD.;Analysis indicated that more mature developmental concepts of illness were significantly related to lower rates of depressive symptomatology. No statistically significant relationship between compliance and other variables was indicated. Qualitative data enhanced understanding of the meaning of illness in patients' lives by providing their personally organized perspective. The social aspect of adaptation was elucidated through the staff discussions. All participants were involved in analysis of the qualitative data.;Results place adaptation in a broader social context. Through a foundation of acceptance of ESRD and dialysis, patients participate in negotiations, based on assimilation and accommodation. This enables patients to integrate illness and health-related needs with other components of their lives. These negotiations cut across the domains of life, including diet, daily schedule, family life, financial status, and social roles. Results are discussed in terms of theoretical implications for developmental psychology and relevance for intervention and prevention efforts. |
