The Effect of Relationship Psychotherapy-Based Counselling Applied to Individuals Receiving Hemodialysis Adjusment to Illness and Depression Levels: A Randomised Controlled Study

INTRODUCTION AND GENERAL INFORMATION Today, increasing life expectancy increases the incidence of chronic diseases. Chronic kidney disease (CKD) is an important health problem that affects all age groups, especially young adults, burdens individuals, their families, and society, has a high risk of developing complications, leads to psychosocial problems, and has increased incidence in recent years both in the world and in our country.

The treatment of CKD varies according to the stage of the disease and the presence of chronic diseases in the individual. In treatment, high blood pressure is generally treated, renal function is protected against angiotensin-converting enzyme inhibitor drugs, plasma glucose levels are controlled in patients with diabetes, high cholesterol levels are reduced with diet and drug therapy, treatment is applied for anemia, treatment is planned for mineral and bone diseases, exercise is recommended, weight control is ensured, and the individual is encouraged to quit smoking. Renal replacement therapies (RRT) are generally applied in individuals with end-stage renal failure (ESRF). Although RRTs prolong life, they may also cause morbidity and mortality. RRT has three types: hemodialysis, peritoneal dialysis, and renal transplantation. In hemodialysis treatment, individuals diagnosed with ESRF may encounter negative effects such as being dependent on treatment programs and devices that last an average of 4-6 hours on certain days of the week (2 or 3), experiencing fear and anxiety due to machine alarms, and loss of time and workforce.

Chronic diseases are diseases that progress rapidly, negatively affect individuals' fulfillment of daily activities, have an uncertain prognosis, may lead to morbidity, affect the individual physically and psychosocially, cause economic problems, and require special care and control for a long time. CKD is one of the serious health problems included in chronic diseases. Despite the treatment methods used in the treatment of CKD, CKD causes physical and emotional problems in individuals, negatively affects their quality of life, and leads to death. Therefore, the adaptation of individuals with this disease to the disease and treatment is very important. Living with a disease such as CKD is a complex, cyclic, dynamic, and ever-changing multidimensional process in which acceptance, coping, and adaptation to the disease are necessary.

Individuals with CKD, especially individuals with ESRF, struggle with many problems in their lives, and their quality of life is negatively affected. One of the most important problems experienced by these individuals is psychosocial adaptation to the disease and complications caused by the disease. Especially hemodialysis treatment is a treatment method that causes changes in the lives of individuals. This treatment method is a process that negatively affects both individuals and families and requires new arrangements in their lives. Change in role performance, loss of health, decreased productivity, loss of power, sexual dysfunction, economic losses, limitation of independence, deterioration in body image, obligation to follow a diet, hopelessness, uncertainty about the future, disruption of family order, fear of death and loss of body functions are among the psychosocial problems experienced by these individuals.

After the acute period, adjustment difficulties and major depression are the most common mental problems in individuals with CKD. Worries about losing their health, physical strength, sexual function, independence, and productivity and experiencing a loss are effective in the occurrence of depressive symptoms in individuals with a diagnosis of CKD. There is a relationship between the deterioration of individuals' physical health and the severity of depressive symptoms. Especially individuals with insufficient psychosocial support resources have a higher risk of depressive symptoms. Depressive symptoms are a common mental problem in hemodialysis patients and are a response to the losses experienced by individuals. The physical health of individuals with a diagnosis of CKD deteriorates because of noncompliance with their diet and treatment and is thought to cause depressive symptoms. Early identification and treatment of individuals with depressive symptoms is very important in terms of continuity of hemodialysis treatment and prevention of suicides. Pharmacologic and nonpharmacologic interventions can be applied to individuals who have depressive symptoms or are diagnosed with depression during hemodialysis treatment. While antidepressants are preferred pharmacologically, nonpharmacological interventions include cognitive behavioral therapy, motivational interviewing, relaxation exercises, regular exercise, social support groups, tele-nursing programs, music therapy, light therapy, healthy nutrition, self-management, problem-solving skills and laughter therapy. When literature is examined, the use of Interpersonal Psychotherapy (IPT) in the treatment of depression seen in individuals with physical illness is increasing.