The relationship between religious coping, psychological distress and quality of life in hemodialysis patients Susana P. Ramirez a , Danielle S. Macêdo b , Paulo Marcelo G. Sales a , Saharoff M. Figueiredo a , Elizabeth F. Daher a , Sônia M. Araújo a , Kenneth I. Pargament c , Thomas N. Hyphantis d , André F. Carvalho a, ⁎ a Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil b Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, CE, Brazil c Department of Psychology, Bowling Green State University, Bowling Green, OH, USA d Department of Psychiatry, Medical School, University of Ioannina, Ioaninna, Greece abstract article info Article history: Received 23 August 2011 Received in revised form 30 November 2011 Accepted 30 November 2011 Keywords: End stage renal disease Dialysis Religion Coping skills Depressive symptoms Quality of life Objective: No studies have evaluated the relationship among religious coping, psychological distress and health-related quality of life (HRQoL) in patients with End stage renal disease (ESRD). This study assessed whether positive religious coping or religious struggle was independently associated with psychological distress and health-related quality of life (HRQoL) in hemodialysis patients. Methods: This cross-sectional study recruited a random sample of 170 patients who had ESRD from three outpatient hemodialysis units. Socio-demographic and clinical data were collected. Patients completed the Brief RCOPE, the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life instrument—Abbreviated version (WHOQOL-Bref). Results: Positive or negative religious coping strategies were frequently adopted by hemodialysis patients to deal with ESRD. Religious struggle correlated with both depressive (r = 0.43; P b .0001) and anxiety (r = 0.32; P b .0001) symptoms. These associations remained significant following multivariate adjustment to clinical and socio-demographic data. Positive religious coping was associated with better overall, mental and social relations HRQoL and these associations were independent from psychological distress symptoms, socio- demographic and clinical variables. Religious struggle was an independent correlate of worse overall, phys- ical, mental, social relations and environment HRQoL. Conclusion: In ESRD, religious struggle was independently associated with greater psychological distress and impaired HRQoL, while positive religious coping was associated with improved HRQoL. These data provide a rationale for the design of prospective and/or intervention studies targeting religious coping in hemodialysis populations. © 2011 Elsevier Inc. All rights reserved. Introduction When end-stage renal disease (ESRD) is diagnosed, a patient re- quires renal replacement therapy, which includes hemodialysis (HD) treatment. Although HD has become a life-prolonging therapy for patients with ESRD, HD patients deal with unique existential dilemmas [1,2]. For instance, ESRD patients on HD might experience conflicts about life and death concerning withholding and withdrawal of dialysis treatment [2,3]. HD patients face major psychological distress [5–7], and the prevalence of depression in the dialysis popu- lation is high and is associated with increased mortality [8]. ESRD patients were found more likely to commit suicide than the general population [9]. Furthermore, hemodialysis is associated with a high prevalence of anxiety symptoms and disorders [5]. Several lines of evidence indicate that patients with ESRD treated with hemodialysis have compromised health-related quality of life (HRQoL) measures when compared to general population norms [9,10]. Individuals coping with the limitations and burden imposed by se- rious medical illnesses often find hope, meaning and support in their connection to the transcendent [11–13]. Evidences relating religion and spirituality to clinical outcomes are accumulating in the medical literature [12,13]. Most studies point to a positive influence of religion on physical health [13]. In the past decade, several studies have investi- gated the influence of religiousness and spirituality in ESRD [14–17]. Religious and spiritual beliefs have been shown to be conducive to bet- ter HRQoL and satisfaction with life and medical care [14,15]. However, some studies have not revealed a positive association between reli- gious beliefs and religiosity with HRQoL in patients undergoing hemo- dialysis [16,17]. A recent study suggests that the existential domain of spirituality was moderately associated with several HRQoL domains, whereas only negligible correlations were verified between religiosity Journal of Psychosomatic Research 72 (2012) 129–135 ⁎ Corresponding author at: Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará; Rua Prof. Costa Mendes, 1608, 4 o andar, 60430-040, Fortaleza, CE, Brazil. E-mail address: andrefc7@terra.com.br (A.F. Carvalho). 0022-3999/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2011.11.012 Contents lists available at SciVerse ScienceDirect Journal of Psychosomatic Research