| Compliance with the medical regimen has been documented as a pervasive and consistent problem among End-Stage Renal Disease (ESRD) patients. The consequences of poor compliance are increased morbidity, mortality, and health care utilization. Depression has been found to be related to compliance in medical patients in general, and in ESRD patients specifically.; The present study investigated a longitudinal model for health care utilization that proposed that compliance affects health care utilization, and that compliance is affected by the patient's mood and by the patient's perspective on him or her self as a person with a chronic illness. Specifically, this research investigated the role depression, illness self-schema, and illness severity play with compliance. In addition, compliance served as a mediator in the prediction of health care utilization.; A second model was investigated in the present study. The second model assessed the relationship between depression and negative illness self-schema over time. Previous studies, (Clemmey, 1997; Guzman, 1998) have determined that depression and negative illness self-schema are significantly correlated among medically ill patients. Specifically, the question of which occurs first, depression or negative illness self-schema, was addressed.; The first model was tested using hierarchical multiple regression. A total of 70 subjects were recruited from the nine San Diego Dialysis Services centers. Subjects completed a depression measure, an illness self-schema measure, and a demographics questionnaire. Data regarding health care utilization, compliance and illness severity were gathered from each subject's medical chart. The overall results did not support the model, although there was a trend toward significance. An individual path within the model was found to be significant. The relationship between depression and health care utilization was mediated by compliance.; The second model was tested using correlational and multiple regression analyses. The results did not provide support for either depression or negative illness self-schema occurring first. However, the results did provide evidence for the stability of these variables over time.; Findings are reviewed in the context of previous and current research in the areas of self-schemas, depression, and compliance. Directions for future research are suggested. Clinical implications based on the results of the present study are discussed. |
