Effect Of Attributive Therapy On Negative Emotions After Kidney Transplantation

?Aim?(1)To explore early postoperative depression and anxiety in renal transplant recipients(2)To explore the effect of attribution therapy on early stress and depression,sleep quality and prognosisa,and to provide reference for integrated psychotherapy on emotional disorder in renal transplant recipients.?Method?A total of 62 patients undergoing renal transplantation in a urological ward in a tertiary general hospital of Fujian Province were randomly selected from December2017 to February 2018 and distributed equally into the trial group(n=31)and control group(n=31)through a randomized number table method.Patients in the trial group were treated with routine renal transplantation postoperative care combined with attribution therapy,while the control group singly received routine nursing care.The intervention period was 4 weeks from the first postoperative day to the 28th.Baseline data,anxiety scale(SAS)Depression Scale(SDS),and attribution style questionnaires(ASQ)were used to evaluate from the first postoperative day.After the intervention,,Pittsburgh Sleep Quality Index(PSQI),fatigue scale(RPFS),and general self-efficacy scale(GSES)were continue included and Medical Coping Style Questionnaire(MCMQ)were evaluated the effect of intervention.The?~2 test,Fisher's test,and Mann-Whitney U test were used to compare the baseline data between the two groups.Independent sample t-test and Mann-Whitney U test were used to compare the depression,anxiety,sleep quality,fatigue,and psychological status between the two groups of inpatients.For the quality status,the Wilcoxon signed rank sum test was used to compare the attribution before and after intervention in the intervention group.Two-factor analysis of variance was used to analyze the intervention factors,time effects and interaction effects of depression.?Results?Main indicator:(1)Depression status:At baseline analysis,the total score of depression in the intervention group was(59.56�7.64)points,and that in the control group showed(61.98�5.34)points,which was higher than the points of the norm of depression,and the difference between them was statistically significant(P<0.05).In addition,there was no significant difference in the total scores of depression between the trial group and the control group(P>0.05)before intervention.After intervention,the total score of depression in the trial group was shown much lower than that in the control group(P<0.05),Furthermore,the number of patients with depression in the trial group was lower than those in the control group,and the difference was shown statistically significant(P<0.05).Comparing the difference of score of depression within the two groups respectively before and after the intervention,the results showed that the difference value of the total score of depression in the control group was shown much lower than that in the trial group,and the difference was statistically significant(P<0.05).Besides,the depression score of the intervention group was similar to the norm after intervention,with no significant difference(P>0.05),while the depression score of the control group was shown significantly higher than that of the norm of the depression,with statistically significant(P<0.05).(2)Anxiety status:At baseline analysis,the total score of anxiety of the trial group was(48.27�8.70),and the total anxiety score of the patients in the control group was(46.45�9.03),which were shown both much higher than the norm of the anxiety score,and the difference between them was statistically significant(P<0.05).There was no significant difference in total anxiety score between the two groups before the intervention(P>0.05).There was alike no significant difference in anxiety scores between the two groups after intervention(P>0.05).The anxiety scores of the two groups were both similar to the norm,with no significant difference(P>0.05)after intervention.(3)Attribution status:At baseline analysis,there was no significant difference in the scores of the attribution styles and the dimensions of the attribution between the patients of trial group and the control group(P>0.05).After the intervention,the scores of the attribution styles and general dimensions of the patients in the intervention group were higher than those in the control group,and the scores of the difference between these two groups was statistically significant(P<0.05),but there was no significant difference between the control group and the trial group neither the dimensions of internal nor external dimensions and stable dimensions(P>0.05);The comparison between the two groups showed that the total score,stable and universal dimensions after intervention in the trial group were significantly higher than those before the intervention,and the difference of the scores was statistically significant(P<0.05).While in the control group,there was no significant difference in the total scores of attribution before and after intervention(P>0.05).Secondary indicator:(1)Medical coping style,self-efficacy,sleep quality and fatigue:The scores of avoidance and yield dimensions in the medical coping styles of the patients in the trial group were shown much lower than those in the control group after intervention,and the difference was statistically significant(P<0.05).While there was no significant difference between the two groups in the facing dimension(P>0.05).Comparing the the scores of the facing and yielding dimensions with the norm(P>0.05),shown the facing scores of the control group were lower than the norm,and the difference was statistically significant(P<0.05),however,the scores of the yielding and avoidance dimensions were shown much higher than the norm,and the difference was statistically significant(P<0.05);As to the total score of self-efficacy,there was no significant difference in self-efficacy scores between the two groups before intervention(P>0.05).There was no significant difference in self-efficacy scores in control group before and after intervention(P>0.05).However,there was a statistically significant difference in self-efficacy scores in intervention group(P>0.05),After intervention,the total score of self-efficacy in the intervention group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05);The total PSQI score,sleep quality,the sleep efficiency,falling and sleep time were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).However,there was no significant difference in scores of daytime dysfunction,hypnotic drugs,sleep disorders,and time to fall asleep between the two groups(P>0.05).The total score of fatigue and cognitive fatigue,emotional fatigue,and physical fatigue in the trial group were all shown much lower than those in the control group,and the difference was statistically significant(P<0.05).Contrary to the dimension of cognitive fatigue between the two groups,there was no significant difference(P>0.05).(2)Laboratory indicator:There was no significant difference in hospitalization time,dialysis time,hemoglobin value,serum creatinine and albumin before intervention between the intervention group and control group(P>0.05).After the intervention,there was no statistically significant differences between these two group in the hospitalization time,serum creatinine,albumin and other indicators.?Conclusion?(1)There was a high proportion level of patients had moderate negative emotions.(2)Attribution training can improve early postoperative depression and attribution style effectively in renal transplant recipients.(3)Attribution training can improve early postoperative fatigue and sleep quality effectively in renal transplant recipients.(4)Attribution training can improve the early postoperative self-efficacy and medical coping style of renal transplant recipients.