Comparison of life expectancy, quality of life, irrational health beliefs, health locus of control and hospital depression in patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital

Introduction: Physical and mental disorders are highly prevalent in patients undergoing hemodialysis and heart transplant and thus reduce the outcomes of patients. Management of these disorders can improve heart and kidney diseases, promote quality of life of patients and reduce their treatment costs. This study compares life expectancy, quality of life, irrational health beliefs, health locus of control, and hospital depression of patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital. Materials and Methods: This cross-sectional study was conducted in 2016 on 190 patients with a history of hemodialysis and heart transplant in Shahid-Rajaee hospital. Data were collected by using adult hope scale, quality of life scale, multidimensional health locus of control (MHLC) scale, irrational belief test, and hospital anxiety and


INTRODUCTION
Mental health is a specialized area of psychiatry in preventing mental diseases, controlling factors contributing to mental diseases and providing a healthy environment for proper mental health and human relations. 1 Currently, one of the new concepts considered in psychological sciences, particularly mental health, is the concept of quality of life. 2 The World Health Organization (WHO) defines quality of life as one's perceptions of life with respect to culture and value system in which one lives and the relationship between these perceptions and his goals, expectations, standards and priorities, which include all important factors and conditions of life such as physical, psychological, social and cultural conditions. Lifestyle refers to a unique model of characteristics and behavioral habits of human in everyday life and social situations. 3 Lifestyle involves behaviors dealing with nutrition, health, personal care and communication, participation in housekeeping, mobility, responsibility, interpersonal relationships, social life, education, work, and leisure. Life expectancy is defined as an inner force which can enrich life, enabling patients to see a vision beyond their current situation of pain and suffer. Lack of life expectancy and purposefulness reduces the quality of life and leads to disappointing beliefs. Future orientation, positive expectations, purposefulness, realism, goal-setting and internal communications are important features of life expectancy. On the contrary, disappointment is defined as tolerance of insuperable situation in which no goal is expected to achieve, and it is associated with depression, death wish, and suicide. By definition, life expectancy involves imagination and attention to future which leads to endeavors of patients assuming that positive outcomes may be achieved. 4 Some psychologists believe that irrational beliefs increase neurotic and psychotic disorders, which gradually lead to the inability to deal with problems of life. Avoidance habit provokes a feeling of inability and inefficiency and gradually predisposes one to use this habit to solve all problems of 1 ORIGINAL ARTICLE life. Compared with healthy subjects, depression has been reported significantly higher in cardiac patients. Another study showed that patients with acute coronary syndrome experienced higher psychological distress in dealing with stressful life events than healthy people; their coping responses were mainly based on emotional inhibition and experienced higher interpersonal conflicts in quality of their relations. 1 Different studies showed that depression is associated with increased risk of death in cases of mild to moderate depression (based on >10 points in Beck questionnaire). In addition to outlining physical problems, diagnosis of heart and kidney diseases causes significant impairment in the mental state of patients. 2 These disorders may include anxiety, depression and future uncertainty. Anxiety and depression are highly prevalent in patients with heart and kidney diseases and reduce treatment outcomes and performance of patients.
Through a descriptive-analytic study on 60 hemodialysis patients, Sajjadi et al. (2008) examined the relationship between self-care and depression in hemodialysis patients and found a strong and negative correlation between self-care and depression. By increasing self-care, depression decreased in patients. Therefore, they recommended that these patients be examined regularly for depressive symptoms in order to be diagnosed in a timely manner. By providing the appropriate context and encouraging patients to increase adherence to self-care behaviors and doing so, psychological and physical complications of hemodialysis treatment can be reduced. Habibzadeh et al. (2012) evaluated the effect of Orem care model on self-efficacy level of 60 patients undergoing hemodialysis. The designed self-care program was performed in three stages for the intervention group, and the results showed significant differences between the intervention and control groups in terms of self-efficacy level. Considering the dependence of hemodialysis patients on receiving care services, it will be helpful to recognize self-care requirements of patients based on nursing theories and care planning inpatient adjustment and increase in self-care activities.
Evaluating the effect of cognitive-behavioral group therapy on problems of dialysis patients, Chen et al. (2008) found that self-care, self-efficacy, quality of life, and quality of sleep were significantly increased in patients compared to control group. Ahmadvand et al. (2012) evaluated the effect of cognitive-behavioral group therapy on anxiety and depression in 36 hemodialysis patients during 12 weeks (once a week) in control and test groups; using Beck's questionnaire, they found that depression score of patients was reduced from 35 to 22, suggesting that group therapy has an effective role in reducing depression in hemodialysis patients.
Moreover, anxiety and depression are the most important factors influencing health-related quality of life; their effects have been reported higher on physical aspects of quality of life such as left ventricular ejection fraction, angina, and other chronic diseases. Depression is a disabling condition which can cause heart and kidney diseases; this disorder has been reported in 20% of patients. 5 This study aimed to compare life expectancy, quality of life, health irrational beliefs, health locus of control and hospital depression in patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital.

MATERIALS AND METHODS
This was a descriptive, analytic and cross-sectional study. The studied population included patients undergoing hemodialysis and heart transplant in Shahid Rajai Hospitals, Tehran. The sample size was estimated at 60 in each group of patients undergoing hemodialysis and heart disease; the samples were recruited by simple random sampling. By considering the likelihood of sample loss, 20 patients were added to the initial sample size. The inclusion criterion was patients undergoing hemodialysis or heart transplant. Written informed consent was obtained from the patients after the objective of the study was explained. Data were collected by using Adult Hope Scale (AHS), quality of life scale, Multidimensional Health Locus of Control (MHLC), Irrational Belief Test (IBT), Hospital Anxiety and Depression Scale (HADS) and a questionnaire including demographic variables. The data collection was completed by interview and review the results with the patients afterward. Reliability of the questionnaires was confirmed by calculating Cronbach's alpha, and the alpha coefficient was estimated to be 0.84 based on a preliminary study on 20 patients using the test-retest method with an interval of 2 weeks. The collected data was analyzed using SPSS. After the distribution of absolute and relative frequency was determined, the statistical t-test was used to analyze the data.

Exclusion criteria included:
1. Unwillingness of the patient or family to continue cooperation; 2. Occurrence of infection-implying symptoms; 3. In the event of a patient's death.

INSTRUMENTS
AHS: This scale was analyzed using ten items based on a scale developed by Snyder with positive and negative orientation. AHS, developed in 1991, is a self-report questionnaire. Hope is an essential element helping people cope with life's difficulties and resist against obstacles. Despite the importance of hope, we find ourselves completely helpless. If you ever had these experiences and felt that you have lost hope, you need to think more about your future and foster it in yourself (Siadatian, et   Independent t-test was used to calculate descriptive variables in order to compare life expectancy, quality of life, health irrational beliefs, health locus of control, and hospital depression in patients undergoing hemodialysis and heart transplant in Shahid-Rajaee hospital.
As shown in Table 2, Kolmogorov-Smirnov score was not significant for all variables. Therefore, distribution of these variables was normal in the groups; thus, parametric tests could be used.
As shown in Table 3, hemodialysis patients and heart transplant patients had significant difference in irrational health beliefs (p=0.001) and hospital depression (p=0.001). On the other hand,

ORIGINAL ARTICLE
hemodialysis patients and heart transplant patients had no significant difference in life expectancy (p=0.70), quality of life (p=0.68) and hospital depression (p=0.21).

CONCLUSION
This study compared life expectancy, quality of life, health irrational beliefs, health locus of control, and hospital depression in hemodialysis patients and heart transplant patients. Findings showed no significant difference in life expectancy between hemodialysis patients and heart transplant patients.
This implies physical disorder in both groups of patients. Reviewing studies related to hope, Banson believes that high levels of hope are positively related to physical and psychological health, high self-worth, positive thinking, and social relations. 8 This finding is consistent with the current study. There was no significant difference in the quality of life of hemodialysis patients and heart transplant patients.
Weakness and fatigue are the most bothersome symptoms of hemodialysis and heart transplant. Benedict et al. showed that fatigue and physical problems are the most disturbing symptoms of disease. 9 Miller and Dishon showed a significant relationship between inability and physical and mental aspects of quality of life; higher inability is associated with lower quality of life. 10 Findings showed a significant difference in irrational health beliefs between hemodialysis and heart transplant patients. Data analysis showed that irrational beliefs were higher in hemodialysis patients than heart transplant patients. One's beliefs and thoughts can influence his or her behavior. In other words, this type of individual beliefs determines behavior, not enabling event, or the same thing happened. Rational beliefs lead to reasonable emotional and behaviors outcomes and help to maintain mental health. 11 On the contrary, irrational beliefs such as excessive anxiety about future, concerns about the availability of goals, and helplessness to changes in life lead to a frequent experience of high levels of stimulation in hemodialysis patients. This feeling of stimulation is frequently experienced by patients who failed to achieve their goals. Moreover, findings showed no significant difference in health locus of control between hemodialysis and heart transplant patients. In patients undergoing hemodialysis and heart transplant, various psychological factors such as health locus of control are important factors in the sense of responsibility for disease control and self-care behaviors. Health locus of control refers to one's belief that his or her health is controlled by internal or external factors. Brannon and Feist showed that patients who rely more on themselves and less on others probably have weaker collaboration with healthcare providers. 12 This study showed a significant difference in hospital depression between hemodialysis patients and heart transplant patients. Data analysis showed that hospital depression was generally higher in heart transplant patients than hemodialysis patients. The higher level of depression in heart transplant patients can be attributed to the fact that these patients assume their disease is more severe, which require more interventions and they stay longer in hospital. This is particularly seen in patients waiting    13 and Glassman et al. 14 Based on current findings, it is suggested to reinforce the idea of health locus of control, particularly internal health locus of control to improve conditions of hemodialysis and heart transplant patients. In homogenous consulting groups (based on education, type of disease, gender, duration, etc.), it is suggested to train coping mechanism, simultaneously with the use of different treatments and then compare their effectiveness.