Personality
Factors
Influencing
Vocational Rehabilitation A.
Kaplan De-Nour, MD,
J. Walter
Czaczkes, PhD, MD
Fifty male patients with chronic renal conditions and receiving hemodialysis underwent psychiatric examination and repeated followups in a predictive study aimed at elucidating personality factors that influence vocational rehabilitation. Previous level of functioning, satisfaction with work, sick role, and patients' dependency needs were found to influence substantially the level of vocational rehabilitation. All the data collected in the present study indicate that "rehabilitation" should start at a much earlier stage and aim at preventing regression. aim of this study has been to gather some information on the factors that influence rehabilita¬ Little is known about the actual rehabilitation of dif¬ ferent patient populations and even less about the factors that influence the level of rehabilitation. Payne mentions that ". understanding of a patient's personality struc¬ ture can be used to manage more effectively the patient's rehabilitation... ,"1 Bibring suggests that when planning rehabilitation, one should ask the question "What kind of activity holds a promise for the patient of fulfilling his emotional needs. ?"2 Rehabilitation of the patient has always been one of the main goals in chronic hemodialysis units. The staff that had to select patients often used "potential for rehabilita¬ tion" as one of the criteria for selection. Abram and Wadlington3 reported that six out of 11 units used "potential for rehabilitation" as one of the criteria for selection. McKegney,4 too, mentions "reasonable expectation for re¬ habilitation resulting in achievement by the patient of a satisfying social role" as one of the criteria for selection. It is not surprising, therefore, that in recent years at¬ tention has been paid to factors influencing vocational re¬ habilitation. Sand et al5 expressed their opinion that these factors depend in part on the patient's personality and need structure and mention "patient's performance as re-
The tion.
.
.
.
Accepted
.
for publication Sept 30, 1974. From the Department of Psychiatry and Nephrological Service, Hadassah University Hospital, Jerusalem, Israel. Reprint requests to the Department of Psychiatry, Hadassah University Hospital, Kiryat Hadassah, Jerusalem, Israel (Dr. De-Nour).
gards employment and motivation to function up to the limits of his physical capacity during his progressive kid¬ ney disease." They also stressed that "a patient who has in
the past demonstrated strong tendencies to use his symp¬ toms for secondary gain would be considered particularly likely to show inadequate rehabilitation." The harmful influence of secondary gain on rehabilita¬ tion was recently described also by Dansak.6 Meldrum et al7 reported results of a predictive study and found that "emotionally stable home environment and a high degree of motivation toward a specific goal are essential for ad¬ aptation." Their prediction of vocational rehabilitation was important with a clear tendency to overestimate the potential for rehabilitation. Education was found to influ¬ ence rehabilitation as well as younger age. The socioeconomic rehabilitation was related to the period of complete disability also before commencement of dialysis treat¬ ment.
Education, as a factor influencing vocational rehabilita¬ tion, was reported also by Short and Alexander8 who men¬ tioned that patients who have been employed in sedentary
occupations
do better in maintaining employment than those in manual occupations. In a small sample of pa¬ tients, we could not find any statistically significant corre¬ lation between patients' intelligence and vocational reha¬ bilitation.9 One of the personality factors often mentioned as ham¬ pering full rehabilitation is high dependency needs.10 " Malmquist,12 in a predictive study, found that rehabili¬ tated patients differed substantially in their way of deal¬ ing with traumatic situations in their attitude toward changes in their lives, and in their expectations of fast re¬ habilitation. Like others, we have gathered the impression that a patient's vocational rehabilitation is influenced by his personality. The present report is part of a predictive study of the influence of a number of personality traits on patients' ad¬ justment to long-term hemodialysis.13 The personality fac¬ tors studied are, to a great extent, those mentioned in the briefly reviewed literature though, at times, under some-
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Iowa User on 05/22/2016
what different
names.
The
hypothesis studied was the fol¬
lowing. A patient's vocational rehabilitation is influenced by a number of personality factors, namely previous (predialysis) level of functioning and satisfaction with work, patient's sick role, and dependency needs. Rehabilitation can, therefore, be predicted by a psychiatric examination
carried out before commencement of treatment. SUBJECTS AND PROCEDURES The Patients
Fifty male patients who started long term hemodialysis during three-year period in seven units were examined before begin¬ ning dialysis, and followed up at six, 12, and 24 months' intervals. Female patients examined in the same units were excluded from a
the present report because most of them were housewives, and exact assessment of rehabilitation of housewives is more difficult than that of patients holding jobs outside the home. The age of the patients (at beginning of dialysis) ranged from 14 to 65 years, with four of them being younger than 20 years and 13 older than 50 years. The patients as a group were of low socioeconomic condi¬ tion as represented also by low education: 16 of the patients did not have an elementary education (five of them were illiterate) and only 12 had a high school education or more. Sixteen of the pa¬ tients were followed up only six months after commencement of dialysis, 15 patients were examined again after a year, and 19 patients were examined again after two years receiving dialysis.
Psychiatric Observations All psychiatric examinations were carried out by the same psy¬ chiatrist a few days to a few months before the patients began di¬ alysis treatment. As described,3 the interview was semistructured, usually 60 minutes long and tape-recorded. A detailed report was written and included, among other data, the following informa¬ tion. Predialysis Level of Functioning.-A detailed work history was gathered with special attention as to how much the patient worked after he was already ill but before the final physical dete¬ rioration. Each patient was rated along a four-point scale: (1) high Table 1.—Rehabilitation: Prediction and Follow-Up Results Prediction
Group Group Group
Rehabilitation Group 1—working full time
3 2
Total 18
0
10
1 16 9 18 * = 28.175
Factors
Influencing
Vocational Rehabilitation A.
Kaplan De-Nour, MD,
J. Walter
Czaczkes, PhD, MD
Fifty male patients with chronic renal conditions and receiving hemodialysis underwent psychiatric examination and repeated followups in a predictive study aimed at elucidating personality factors that influence vocational rehabilitation. Previous level of functioning, satisfaction with work, sick role, and patients' dependency needs were found to influence substantially the level of vocational rehabilitation. All the data collected in the present study indicate that "rehabilitation" should start at a much earlier stage and aim at preventing regression. aim of this study has been to gather some information on the factors that influence rehabilita¬ Little is known about the actual rehabilitation of dif¬ ferent patient populations and even less about the factors that influence the level of rehabilitation. Payne mentions that ". understanding of a patient's personality struc¬ ture can be used to manage more effectively the patient's rehabilitation... ,"1 Bibring suggests that when planning rehabilitation, one should ask the question "What kind of activity holds a promise for the patient of fulfilling his emotional needs. ?"2 Rehabilitation of the patient has always been one of the main goals in chronic hemodialysis units. The staff that had to select patients often used "potential for rehabilita¬ tion" as one of the criteria for selection. Abram and Wadlington3 reported that six out of 11 units used "potential for rehabilitation" as one of the criteria for selection. McKegney,4 too, mentions "reasonable expectation for re¬ habilitation resulting in achievement by the patient of a satisfying social role" as one of the criteria for selection. It is not surprising, therefore, that in recent years at¬ tention has been paid to factors influencing vocational re¬ habilitation. Sand et al5 expressed their opinion that these factors depend in part on the patient's personality and need structure and mention "patient's performance as re-
The tion.
.
.
.
Accepted
.
for publication Sept 30, 1974. From the Department of Psychiatry and Nephrological Service, Hadassah University Hospital, Jerusalem, Israel. Reprint requests to the Department of Psychiatry, Hadassah University Hospital, Kiryat Hadassah, Jerusalem, Israel (Dr. De-Nour).
gards employment and motivation to function up to the limits of his physical capacity during his progressive kid¬ ney disease." They also stressed that "a patient who has in
the past demonstrated strong tendencies to use his symp¬ toms for secondary gain would be considered particularly likely to show inadequate rehabilitation." The harmful influence of secondary gain on rehabilita¬ tion was recently described also by Dansak.6 Meldrum et al7 reported results of a predictive study and found that "emotionally stable home environment and a high degree of motivation toward a specific goal are essential for ad¬ aptation." Their prediction of vocational rehabilitation was important with a clear tendency to overestimate the potential for rehabilitation. Education was found to influ¬ ence rehabilitation as well as younger age. The socioeconomic rehabilitation was related to the period of complete disability also before commencement of dialysis treat¬ ment.
Education, as a factor influencing vocational rehabilita¬ tion, was reported also by Short and Alexander8 who men¬ tioned that patients who have been employed in sedentary
occupations
do better in maintaining employment than those in manual occupations. In a small sample of pa¬ tients, we could not find any statistically significant corre¬ lation between patients' intelligence and vocational reha¬ bilitation.9 One of the personality factors often mentioned as ham¬ pering full rehabilitation is high dependency needs.10 " Malmquist,12 in a predictive study, found that rehabili¬ tated patients differed substantially in their way of deal¬ ing with traumatic situations in their attitude toward changes in their lives, and in their expectations of fast re¬ habilitation. Like others, we have gathered the impression that a patient's vocational rehabilitation is influenced by his personality. The present report is part of a predictive study of the influence of a number of personality traits on patients' ad¬ justment to long-term hemodialysis.13 The personality fac¬ tors studied are, to a great extent, those mentioned in the briefly reviewed literature though, at times, under some-
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Iowa User on 05/22/2016
what different
names.
The
hypothesis studied was the fol¬
lowing. A patient's vocational rehabilitation is influenced by a number of personality factors, namely previous (predialysis) level of functioning and satisfaction with work, patient's sick role, and dependency needs. Rehabilitation can, therefore, be predicted by a psychiatric examination
carried out before commencement of treatment. SUBJECTS AND PROCEDURES The Patients
Fifty male patients who started long term hemodialysis during three-year period in seven units were examined before begin¬ ning dialysis, and followed up at six, 12, and 24 months' intervals. Female patients examined in the same units were excluded from a
the present report because most of them were housewives, and exact assessment of rehabilitation of housewives is more difficult than that of patients holding jobs outside the home. The age of the patients (at beginning of dialysis) ranged from 14 to 65 years, with four of them being younger than 20 years and 13 older than 50 years. The patients as a group were of low socioeconomic condi¬ tion as represented also by low education: 16 of the patients did not have an elementary education (five of them were illiterate) and only 12 had a high school education or more. Sixteen of the pa¬ tients were followed up only six months after commencement of dialysis, 15 patients were examined again after a year, and 19 patients were examined again after two years receiving dialysis.
Psychiatric Observations All psychiatric examinations were carried out by the same psy¬ chiatrist a few days to a few months before the patients began di¬ alysis treatment. As described,3 the interview was semistructured, usually 60 minutes long and tape-recorded. A detailed report was written and included, among other data, the following informa¬ tion. Predialysis Level of Functioning.-A detailed work history was gathered with special attention as to how much the patient worked after he was already ill but before the final physical dete¬ rioration. Each patient was rated along a four-point scale: (1) high Table 1.—Rehabilitation: Prediction and Follow-Up Results Prediction
Group Group Group
Rehabilitation Group 1—working full time
3 2
Total 18
0
10
1 16 9 18 * = 28.175
