Psychiatry and Clinical Neurosciences (2007), 61, 339–347 doi:10.1111/j.1440-1819.2007.01716.

Regular Article
Personality types and coping style in
hemodialysis patients
RURIKO KIDACHI, rn, phd,1 ATSUHIRO KIKUCHI, md, phd,4
YOSHIKO NISHIZAWA, rn, phd,2 TOMIHARU HIRUMA, md, phd5 AND
SUNAO KANEKO, md, phd3
1
Department of Development and Aging, 2Department of Health Promotion, Division of Health Sciences,
Graduate School of Health Sciences, 3Department of Neuropsychiatry, Graduate School of Medicine,
Hirosaki University, 4Department of Neuropsychiatry, Hirosaki University Hospital, Hirosaki, Aomori and
5
Department of Neuropsychiatry, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan

Abstract The aim of this study was to obtain information that would enable caregivers to provide the
necessary psychological care for hemodialysis patients. A total of 608 hemodialysis patients com-
pleted the questionnaire of the Neuroticism, Extroversion, Openness–Five Factor Inventory and
were subsequently classified by personality types using cluster analysis. In comparison to the norms
for the general Japanese adult population, the four-dimensional average of extroversion, open-
ness, agreeableness, and conscientiousness among hemodialysis patients was significantly lower
(P < 0.001), especially for openness. The openness score correlated with each of the following: age
(P < 0.001), employment (P < 0.01), and diabetes (P < 0.001). Four personality types were defined
based on these dimensions. High scores for agreeableness, extroversion and conscientiousness
characterized the agreeable type (22.6%). The patients in this type will likely accept their own
experiences in a positive manner. Submissive types (22.0%) received the lowest scores for consci-
entiousness, though extroversion, openness, and agreeableness were also low. It is necessary to
enhance a sense of independence and responsibility in patients with submissive type personalities.
Sensitive types (21.5%) were characterized by the highest neuroticism scores and low scores for the
other four dimensions. The patients in this type were likely to be persistent with changes in
conditions. The last type was the balanced type (33.9%), which was defined by scores within mean
range. In clinical practice, it is particularly important that the submissive and sensitive types should
receive appropriate mental health care.

Key words caregiver, coping style, hemodialysis patient, mental health, personality.

INTRODUCTION Patients, 2006). Dialysis patients are constantly aware

The number of patients receiving hemodialysis is
increasing annually in Japan, with the number of
patients receiving treatment reaching 257 765 in 2005
(according to the Japan Association of Kidney Disease
Correspondence address: Ruriko Kidachi, RN, PhD, Depar-
tment of Development and Aging, Division of Health Sciences,
Graduate School of Health Sciences, Hirosaki University, 66-1
Hon-cho, Hirosaki-shi, Aomori-ken 036–8564, Japan. Email:
kidachi@cc.hirosaki-u.ac.jp
Received 7 November 2005; revised 2 April 2007; accepted 8 April
2007.
of their physical deficiency, yet they also face serious
life-threatening complications caused by hemodialysis,
such as disequilibrium syndrome. In addition to these
factors, restrictions of diet and fluids, as well as limited
occupational and social activities, are reported to cause
stress in dialysis patients.1,2 Recently, the age of long-
term dialysis patients and the mean age at dialysis ini-
tiation have increased. For elderly dialysis patients, the
physical inconvenience associated with aging, as well
as social and economic difficulties, also contribute to
stress. Consequently, it is necessary for caregivers and
health-care professionals to understand the psycho-
logical status of hemodialysis patients.

© 2007 The Authors

Journal compilation © 2007 Folia Publishing Society
340
The mental health care of hemodialysis patients
requires collaborative treatments in which people with
a variety of backgrounds are involved, with psycho-
nephrology (counseling and drug administration) by
psychiatrists being primary. However, providing care
according to the patient’s mental condition at a given
time, as well as taking into account an individual’s
background, the course of the illness, and his/her
mental status are difficult and often left to the indivi-
dual’s discretion.
Many of the previously reported studies on the
mental health aspects of hemodialysis have used
various scales to quantitatively examine the relation-
ship between outcomes such as quality of life, self-
management or adherence, and the patient’s
background.3 For instance, there are some studies to
clarify stress-coping mechanisms,4–7 the relationship
between self-management behaviors, and self-efficacy
of dialysis patients.8–11 Despite the fact that patient out-
comes seem to vary according to mental status, only
few investigations on the relationship between behav-
ior and personality have been conducted.12–15 The
authors assumed that if personality types could be
identified, appropriate caregiving methods could be
devised based on these types. Therefore, this study
aimed to classify personality types of hemodialysis
patients.
METHODS
In 2002, a cross-sectional study using random sampling
was conducted by mailed questionnaires. The authors
explained the purpose of the study to a responsible
person at a self-help association for hemodialysis
patients located in Aomori prefecture, Japan, and
obtained permission to question its members. Disclo-
sure and informed consent forms were enclosed in
envelopes with questionnaires based on the Neuroti-
cism, Extroversion, Openness–Five Factor Inventory
(NEO-FFI).
The NEO-FFI consists of a total of 60 items, with 12
items for each of the five main personality dimensions
from the 240 items of the Revised NEO Personality
Inventory (NEO-PI-R). It is a self-report study, rated
on a 5-point Likert-type scale. The Japanese versions of
the NEO-PI-R and the NEO-FFI have been translated
and standardized, and reliability has also been
obtained.16
The neuroticism dimension includes facets such as
anxiety, angry-hostility, depression, self-consciousness,
and vulnerability. The extroversion dimension includes
facets such as warmth, gregariousness, assertiveness,
activity, excitement, and other positive emotions. The
openness dimension includes facets such as fantasy,
© 2007 The Authors
Journal compilation © 2007 Folia Publishing Society
R. Kidachi et al.
aesthetics, feelings, actions, ideas, and values.The agree-
ableness dimension includes facets such as trust,
straightforwardness, altruism, and compliance. Finally,
the conscientiousness dimension includes facets such as
order, dutifulness, achievement striving, determination,
and self-discipline.
The envelopes were distributed to 1700 members of
the self-help association via contact persons of the
branch association and collected after 20 days. The
location from which patients replied was not recorded,
but many respondents filled out the questionnaires on
dialysis beds.
Patients were deemed to have given their consent for
the study when their replies were received. The
response rate was 44.1% and the number of valid
responses was 608. The authors believe that the
response rate was low because it was not possible to
obtain responses from patients who had difficulty com-
pleting the questionnaires without help.
Several statistical tests were conducted to analyze
the data. The Pearson’s rank correlation analysis was
performed to examine the relationship among the five
dimensions of the NEO-FFI. T-tests were conducted to
assess differences between hemodialysis patients and
the general adult population in Japan as well as differ-
ences among gender, age, employment, duration of
hemodialysis, and complications. These results were
subsequently used to assess the characteristics of per-
sonality types using anova. The relationship between
personality types and demographic characteristics was
assessed using the c2-test. For all statistical analyses,
differences were considered significant at P < 0.05. All
analyses were conducted using the SPSS statistical
package version 13.0 (SPSS Inc., Chicago, IL, USA).
Selected patient characteristics are summarized in
Table 1. The patients’ ages ranged from 19 to 90 years
(mean, 58 years and 3 months), the duration of hemo-
dialysis ranged from 1 month to 27 years and 6 months
(mean, 6 years and 7 months), the percentage of males
in the sample was 56.5%, and the percentage of
working persons (including farmers and the self-
employed) was 22.2%. Percentages of patients with
complications were as follows: diabetes mellitus 25.2%,
retinopathy 22.2%, diabetes mellitus with retinopathy
15.4%, cardiac disease 20.4%, diabetes mellitus with
cardiac disease 7.1%, hyperparathyroidism 15.9%, and
cerebral apoplexy 7.8%.
Ethical considerations
Studies were conducted after providing sufficient
written explanation to the patients regarding the
purpose of the studies and the protection of personal
Personality in hemodialysis patients 341

Table 1. Demographic characteristics of hemodialysis P = 0.0001) and conscientiousness (r = 0.310, P =

patients 0.0001), and agreeableness was positively correlated
with conscientiousness (r = 0.271, P = 0.0001). How-
n = 608 ever, all correlation coefficients were relatively low
despite the significant results.
Age
Table 3 shows the comparisons between hemodialy-
Mean ⫾ SD (years) 58.3 ⫾ 12.8
Range (years) 19–90 sis patients and the general Japanese population across
<65 years 66.0% the five dimensions of the NEO-FFI;16 hemodialysis
ⱖ65 years 33.7% patients scored significantly lower for extroversion
Missing 0.3% (t = 7.368, d.f. = 535, P = 0.0001), openness (t = 15.396,
Duration of hemodialysis d.f. = 498, P = 0.0001), agreeableness (t = 7.254, d.f. =
Mean ⫾ SD (years) 6.7 ⫾ 5.7 507, P = 0.0001) and conscientiousness (t = 7.002, d.f. =
Range (years) 0.1–27.6 528, P = 0.0001), but not for neuroticism.
<3 years 28.2% In terms of relationships with patient backgrounds
ⱖ3 years 70.5% (Table 4), the neuroticism score was lower in patients
Missing 1.3%
65 years of age or older (t = 2.174, d.f. = 213, P = 0.031).
Gender percentage
The scores for extroversion (t = 2.383, d.f. = 165,
Male 56.5%
Female 43.0% P = 0.018) and conscientiousness (t = 2.813, d.f. = 171,
Missing 0.5% P = 0.005) were higher in employed patients, and score
Employment percentage for openness was higher in patients who were less than
Employed 22.2% 65 years of age (t = 4.225, d.f. = 232, P = 0.0001) and
Unemployed 72.3% who were employed (t = 3.098, d.f. = 163, P = 0.002).
Missing 5.5% The agreeableness score was higher in females
Complication percentage (t = 3.230, d.f. = 352, P = 0.001).
Diabetes mellitus 25.2% The differences in patients with and without comor-
Retinopathy 22.2% bidities were examined using a paired t-test of the
Diabetes mellitus with retinopathy 15.4%
five-dimensional average of personality (Table 5). The
Hyperparathyroidism 15.9%
neuroticism score was significantly higher in patients
Diabetes mellitus with hyperparathyroidism 2.3%
Cardiac disease 20.4% with hyperparathyroidism (t = 2.322, d.f. = 322, P =
Diabetes mellitus with cardiac disease 7.1% 0.021), while the extroversion score was significantly
Cardiac disease with hyperparathyroidism 4.1% lower in patients with cardiac disease (t = 2.703, d.f =
Cerebral apoplexy 7.8% 155, 110, P = 0.008) or cerebral embolism (t = 2.715,
Diabetes mellitus with cerebral apoplexy 2.7% d.f. = 32, 458, P = 0.011). The openness score in patients
Cardiac disease with cerebral apoplexy 2.8% with diabetes was significantly lower (t = 3.078, d.f. =
218, 105, P = 0.002), but it was significantly higher in
patients with retinopathy (t = 2.254, d.f. = 160, 982,
P = 0.026) or hyperparathyroidism (t = 2.724, d.f. = 89,
information. The authors maintained strict control over 349, P = 0.008).
the collected data to prevent disclosure of confidential
information. Personality types of the hemodialysis patients
based on the Neuroticism, Extroversion,
RESULTS Openness–Five Factor Inventory

Personality of the hemodialysis patients based
on the Neuroticism, Extroversion,
Openness–Five Factor Inventory
The 60 items of the NEO-FFI demonstrated high inter-
nal consistency with a Cronbach’s alpha of 0.71. Table 2
shows the correlations among the five dimensions of
the NEO-FFI. Neuroticism was negatively correlated
with extroversion (r = -0.218, P = 0.0001) and agree-
ableness (r = -0.342, P = 0.0001). Extroversion was
positively correlated with agreeableness (r = 0.247,
Cluster analysis included 381 subjects who had com-
plete data for all items of the NEO-FFI. Personality
types were classified into four categories, which was the
maximum number that enabled the characteristics of
each dimension to be distinguished by type. Each cat-
egory was named on the basis of the characteristics of
the five dimensions. One-way anova showed that dif-
ferences in personality types were statistically signifi-
cant for neuroticism (F3,377 = 124.553, P = 0.0001),
extroversion (F3,377 = 84.195, P = 0.0001), openness
(F3,377 = 12.066, P = 0.0001), agreeableness (F3,377 =

© 2007 The Authors

Journal compilation © 2007 Folia Publishing Society
342 R. Kidachi et al.

Table 2. Correlations among the five dimensions of the Neuroticism, Extroversion, Openness–Five Factor Inventory (n = 608)

Dimension Neuroticism Extroversion Openness Agreeableness

Neuroticism –
Extroversion -0.218*** –
Openness 0.058 0.140 –
Agreeableness -0.342*** 0.247*** 0.151 –
Conscientiousness -0.103 0.310*** 0.178 0.271***

Pearson’s correlation coefficient. *** P < 0.001.

Table 3. Differences between hemodialysis patients and the general Japanese population across the five dimensions of the
Neuroticism, Extroversion, Openness–Five Factor Inventory

Score of the hemodialysis patients Score of the general adult population in Japan16
Dimensions n Mean SD n Mean SD t-value

Neuroticism 608 23.5 5.7 334 23.4 6.9 0.207

Extroversion 608 23.5 5.5 330 25.2 5.8 7.368***
Openness 608 24.9 4.6 334 28.1 5.5 15.396***
Agreeableness 608 29.4 4.5 333 30.9 4.7 7.254***
Conscientiousness 608 26.7 5.4 328 28.4 5.5 7.002***

One sample t-test was applied. *** P < 0.001.

Data on the general Japanese population is based on the study by Shimonaka et al.16

Table 4. Differences in the five dimensions of the Neuroticism, Extroversion, Openness–Five Factor Inventory by gender, age,
employment, and duration hemodialysis

Dimensions
Neuroticism Extroversion Openness Agreeableness Conscientiousness
n Mean SD Mean SD Mean SD Mean SD Mean SD

Gender
Male 220 23.3 5.7 23.5 5.7 24.7 4.6 28.8 4.6** 27.0 5.2
Female 161 24.2 6.0 23.8 5.2 25.3 4.5 30.3 4.5** 26.3 5.9
Age
<65 years 272 24.1 5.9* 23.6 5.6 25.5 4.6*** 29.3 4.4 26.4 5.5
ⱖ65 years 109 22.7 5.5* 23.6 5.0 23.5 4.0*** 29.9 5.2 27.5 5.6
Employment
Employed 92 23.2 5.8 24.8 5.2* 26.1 4.4** 29.5 4.2 28.1 5.1
Unemployed 268 23.6 5.9 23.3 5.5* 24.5 4.5** 29.6 4.6 26.3 5.6
Duration of hemodialysis
<3 years 118 23.8 5.5 23.7 5.6 24.4 4.7 29.1 5.0 27.3 6.2
ⱖ3 years 257 23.7 6.0 23.5 5.4 25.3 4.4 29.6 4.5 26.5 5.2

T-test was applied. * P < 0.05, ** P < 0.01, *** P < 0.001.

78.943, P = 0.0001), and conscientiousness (F3,377 = (1) Among the agreeable type (22.6%), agreeableness
98.578, P = 0.0001). Post-hoc multiple comparisons was higher than the other three personality types
among the personality types were conducted, as shown (P = 0.0001), as expected. Conscientiousness was
in Fig. 1. higher than the submissive type (P = 0.0001) and

© 2007 The Authors

Journal compilation © 2007 Folia Publishing Society
Personality in hemodialysis patients 343

Table 5. Differences in the five dimensions of the Neuroticism, Extroversion, Openness–Five Factor Inventory by complications

Dimensions
Neuroticism Extroversion Openness Agreeableness Conscientiousness
n Mean SD Mean SD Mean SD Mean SD Mean SD

Diabetes mellitus 102 23.0 5.8 23.4 5.7 23.8 4.1** 29.0 5.4 27.0 5.1
236 23.6 5.7 24.1 5.3 25.4 4.7** 30.0 4.3 27.2 5.5
Retinopathy 92 23.5 5.6 23.3 5.4 25.5 4.6** 28.8 5.4 26.7 5.4
238 23.6 5.7 24.2 5.4 24.1 4.5** 29.9 4.3 27.2 5.5
Cardiac disease 85 24.0 6.0 22.4 5.2** 24.5 4.3 29.7 4.9 26.3 5.6
250 23.5 5.6 24.2 5.6** 25.1 4.6 29.6 4.6 27.2 5.4
Hyperparathyroidism 61 25.2 7.3* 22.8 5.8 26.6 4.6** 29.5 5.0 26.4 5.4
263 23.3 5.5* 24.3 5.4 24.8 4.5** 29.7 4.5 27.2 5.4
Cerebral apoplexy 27 23.7 6.6 21.3 4.7* 23.2 5.1 30.3 5.0 25.9 6.9
312 23.6 5.6 23.9 5.5* 25.1 4.5 29.5 4.6 26.9 5.4

T-test was applied. * P < 0.05, ** P < 0.01, *** P < 0.001.

Figure 1. Comparison of the five

dimensions of the Neuroticism, Extro-
version, Openness–Five Factor Inven-
tory across four personality types.
ANOVA with multiple comparisons
was applied. * P < 0.05, ** P < 0.01,
*** P < 0.001.

© 2007 The Authors

Journal compilation © 2007 Folia Publishing Society
344
Table 6. Personality types of hemodialysis patient by age
Personality types of hemodialysis patient
Age Agreeable type
<65 years (n = 272) 49 (18.0%)
ⱖ65 years (n = 109) 37 (33.9%)
c2-test was applied. F = 11.722, d.f. = 3, P = 0.008.
the sensitive type (P = 0.0001). Neuroticism was
lowest among the personality types (P = 0.0001).
(2) Among the submissive type (22.0%), conscien-
tiousness was lowest compared to the other per-
sonality types (P = 0.0001).
(3) Among the sensitive type (21.5%), as expected,
neuroticism was the highest (P = 0.0001), but
extroversion and agreeableness were lower than
the other personality types (P = 0.0001). Openness
was lower than the balanced type (P = 0.0001).
(4) Among the balanced type (33.9%), openness was
higher than the other personality types (P = 0.011),
but the five dimensions were all within the mean
range.
Table 6 reveals a notable relationship between per-
sonality type and age. There was a large number of
agreeable type and a small number of sensitive type
among patients 65 years of age or older (c2 = 11.722,
d.f. = 3, P = 0.008).
DISCUSSION
Characteristics of hemodialysis patients in
comparison with the general adult population
According to the NEO-PI-R study by Shimonaka
et al. on correlations among the five dimensions of
personality in the general Japanese adult population,
extroversion and agreeableness were negatively cor-
related.16 However, this study found that hemodialysis
patients were quite different from the general adult
population, given that extroversion and agreeableness
were positively correlated. The high agreeableness
score among patients with high extroversion scores
may be a result of their positive acceptance of a
variety of difficulties associated with hemodialysis, as
extroversion indicates activity and positive emotions.
This study also showed that hemodialysis patients do
not differ from the general adult population with
regard to neuroticism, but the patients’ scores on all
other four dimensions were significantly lower.
However, it cannot be generalized that neuroticism
© 2007 The Authors
Journal compilation © 2007 Folia Publishing Society
R. Kidachi et al.
Submissive type Sensitive type Balanced type
62 (22.8%) 61 (22.4%) 100 (36.8%)
22 (20.2%) 21 (19.3%) 29 (26.6%)
among hemodialysis patients is the same as the
general adult population because, by type, they
include persons with high neurotic tendencies with
high psychological sensitivity and persons with agree-
able tendencies who tend not to worry. It is important
to note that among hemodialysis patients with lower
scores on the other four dimensions, openness was
especially lower in comparison with the general adult
population. The fact that the openness score, which
relates to curiosity, proactiveness, and creativity, is
lower appears to indicate a variety of limitations in
their lives, including the deterioration in their bodily
functions.17
The tendency for female patients to have higher
agreeableness scores is also true in the general Japa-
nese female population,16 and likewise, neuroticism
and openness scores are confirmed to be low in both
aged hemodialysis patients and the general aged Japa-
nese population.18 Therefore, gender and age do not
appear to be unique features among hemodialysis
patients.
In Japan, the population is aging rapidly. Depression
and suicide among the elderly have become a prob-
lem.19 A relationship between advanced age, depres-
sion and high neuroticism has been reported.20–25
Nevertheless, the present findings did not show high
neuroticism scores in the elderly, with only a small
number of elderly patients of the sensitive type. These
findings may be a result of low recognition of stress or
an abandonment of their life by the elderly.24 Although
the number of elderly patients of the sensitive type was
small, the authors think that sensitive psychological
care is necessary because persons with this type are
likely to develop depression.19
A study of hemodialysis patients using the GHQ30
showed that scores for items measuring social dysfunc-
tion and suicidality-depression were higher in unem-
ployed patients.26 Given the positive correlation found
between employment and openness in this study, the
authors surmise that employment among hemodialysis
patients is significant in terms of giving meaning to
their lives, despite apparent difficulties associated with
work.
Personality in hemodialysis patients
Personality characteristics associated
with comorbidities
With regard to findings obtained with the use of the
NEO-FFI, studies of mental disorders have reported
that patients with schizophrenia or delusion have high
scores in the neuroticism and extroversion dimen-
sions,20 with especially high scores for extroversion in
obsessive–compulsive neurosis patients.21
Vulnerability, which is a facet of neuroticism, has
been reported as an index for complications of post-
stroke depression.22 This study suggests that negative
symptoms, such as vulnerability, influence neuroticism
in hemodialysis patients with hyperparathyroidism.
Furthermore, there is a negative correlation between
drug compliance among depressed patients and extro-
version, particularly with respect to activity.23 The
current study also suggests that due to their lower
extroversion, hemodialysis patients with cardiac
disease or cerebral embolism tend to have negative
psychological states.Although previous studies point to
a correlation between ischemic heart disease and the
angry-hostility feature of neuroticism,27 the authors
might have failed to observe the same relationship pos-
sibly because the NEO-FFI includes only one angry-
hostility item.
In patients with diseases other than mental disorders,
a positive correlation has been shown between neuroti-
cism and mortality among elderly patients,24 as well as
a tendency for recalling negative memories among
elderly patients with low extroversion scores.25 These
findings suggest that neuroticism and extroversion are
closely associated with mental conditions. The fact that
patients with diabetes had lower openness scores and
that patients with retinopathy or hyperparathyroidism
had higher openness scores appear to suggest that
bodily disadvantage may increase openness.
Personality types and coping style among
hemodialysis patients
It may be meaningful to characterize the individual
personality types of hemodialysis patients to provide
better individualized mental care. Here, the authors
describe the four personality types of hemodialysis
patients and suggest the ways to provide care for each
type.
Agreeable type
Among the agreeable type, as expected, agreeableness
was the strongest dimension. Extroversion and con-
scientiousness scores were also slightly high in this
agreeable type. Fundamentally, it indicates an altruis-
345
tic personality. The high extroversion score signified
having a strong interest in many issues, being active and
talkative, seeking excitement, and having an optimistic
attitude. Persons with a high conscientiousness score
were moralistic and trusted by other people. Moreover,
because of low neuroticism, people of this agreeable
type were mentally stable and able to cope calmly
with very stressful situations. The openness score was
slightly low, but the score for this dimension was
generally low in dialysis patients.
The authors think that combined with the other char-
acteristics of this type, these patients are easily able to
adapt to dialysis life.
People of the agreeable type are psychologically
independent, likely to have strong decision-making
skills, and build favorable human relationships, there-
fore, the authors assume that they do not have difficulty
in seeking advice. However, in order for these individu-
als to maintain a stable mental condition, care provid-
ers may be required to inform them that mental health
care is readily available whenever requested, while
encouraging their altruistic qualities.
The agreeable type was frequently seen among
elderly patients. Pre-war norms had a great impact on
the personality formation of the current elderly gen-
eration in Japan. At that time, the ability to adjust
oneself to the values of the group to which one
belonged, instead of insisting on one’s rights or liberty,
was a desirable virtue. The authors thought that the
large number of altruistic and agreeable types among
the elderly patients was as a result of the characteristics
of this generation.
Persons with agreeable-type personalities are easily
able to maintain self-discipline and successfully self-
manage their conditions. Nonetheless, for the elderly,
there are handicaps in terms of knowledge, understand-
ing, capacity for action etc. They also have difficulty
changing their habits and values. Therefore, because
the evidence suggests that elderly people are more
likely to follow the directions of health-care profes-
sionals and prefer tailored living arrangements, con-
ventional living instructions should be provided.
Submissive type
Low conscientiousness does not mean that a person
entirely lacks the capacity to act according to moral
principles. Rather, it means they do not make a suffi-
cient effort to achieve objectives. Other characteristics
include a lack of self-assertiveness or strong interest in
issues, an unwillingness to perform activities or reach
goals, and a suspicion of other people.16 Therefore,
dialysis patients of the submissive type tend to rely on
specialists rather than acting on their own to cope with
© 2007 The Authors
Journal compilation © 2007 Folia Publishing Society
346
the disease; they even accept the fact that the disease
has progressed as a result of their submissive nature.
A low level of goal orientation may make disease
self-management difficult. Persons of the submissive
type may not accumulate control methods from expe-
rience, as they are influenced by the directions given
by specialists.10 Health-care professionals often miss
changes in medical conditions because the patients do
not tend to assert themselves. As a result, health-care
professionals are oftentimes frustrated by the aggra-
vation of the disease in submissive types due to this
issue. Consequently, it is suggested that health-care
professionals encourage patients to report their com-
plaints and promote independence and self-discipline,
while making patients aware that they primarily are
responsible for control of their physical condition. To
achieve this, explanations should be given to patients
so they can obtain a sufficient understanding of their
disease, and health-care professionals also need to be
actively and continuously involved in the lives of their
patients.
Sensitive type
Persons with a high score for neuroticism cannot easily
control their anger and are less able to cope with stress
than other people.16 If extroversion is low, there is a
strong sense of dependency. If people have low open-
ness, they are conservative and do not show strong
emotional reactions. If people have low agreeableness,
they are self-centered and distrustful. In simple terms,
these people are sensitive to stress, and their reactions
tend to be introverted. A good aspect of the coping
styles of patients of the sensitive type is that they get
involved in the details of their treatment and decision-
making. Consequently, health-care professionals must
respect their attitude for engaging in treatment and
provide them with accurate and honest explanations in
order for them to make decisions.
Balanced type
In type classifications, an intermediate, ‘balanced’ type
will sometimes be identified. In this type, all of the five
dimensions had average values, and there were no
notable characteristic coping styles compared with the
other types. Consequently, there is insufficient informa-
tion for consideration on the specific support required
for patients of this type. Further studies are needed to
identify what kind of coping styles are applied by them
and what kind of care is needed for those falling into
this category.
© 2007 The Authors
Journal compilation © 2007 Folia Publishing Society
R. Kidachi et al.
LIMITATIONS AND CLINICAL
IMPLICATIONS
This study was able to categorize the personalities of
dialysis patients into four types. In clinical practice, if a
patient’s personality type can be identified, it becomes
possible to implement type-oriented methods for pro-
viding explanations to patients and obtaining their
informed consent, as well as for getting involved in the
lives of patients, and providing instructions on disease
self-management. It is particularly important that the
submissive and sensitive types should receive appropri-
ate mental health care.
ACKNOWLEDGMENT
This study was supported by a Grant-in-Aid for Scien-
tific Research from the Japanese Ministry of Educa-
tion, Culture, Sports, Science and Technology of Japan
(14572263).
REFERENCES
1. Baldree KS, Murphy SP, Powers MJ. Stress identification
and coping patterns in patients on hemodialysis. Nurs.
Res. 1982; 31: 107–112.
2. Gurklis JA, Menke EM. Identification of stressors and
use of coping methods in chronic hemodialysis patients.
Nurs. Res. 1988; 37: 236–239.
3. Morgan LA. Decade review: methods to improve adher-
ence to the treatment among haemodialysis patients.
EDTNA. ERCA. J. 2001; 27: 7–12.
4. Greenberg IM, Weltz S, Spitz C, BizzozeroOJ Jr. Factors
of adjustment in chronic hemodialysis patients. Psycho-
som 1975; 16: 178–184.
5. Ersoy KM, Güldü Ö. Vulnerability to stress, perceived
social support, and coping styles among chronic hemodi-
alysis patients. Dial. Transplant. 2005; 34: 662–671.
6. Lok P. Stressors, coping mechanisms and quality of life
among dialysis in Australia. J. Adv. Nurs. 1996; 23: 873–
881.
7. Mok E, Tam B. Stressors and coping methods among
chronic haemodialysis patients in Hong Kong. L. Clin.
Nurs. 2001; 10: 503–511.
8. Tsay SL, Healstead M. Self-care, self-efficacy, depression,
and quality of life among patients receiving hemodialysis
in Taiwan. Int. J. Nurs. Stud. 2002; 39: 245–251.
9. Welch JL, Perkins SM, Evans JD, Bajpai S. Differences in
perceptions by stage of fluid adherence. J. Ren. Nutr.
2003; 13: 275–281.
10. Takaki J, Nishi T, Shimoyama H et al. Interactions among
a stressor, self-efficacy, coping with stress, depression, and
anxiety in maintenance hemodialysis patients. Behav.
Med. 2004; 29: 107–112.
11. Takaki J, Yano E. Possible gender differences in the rela-
tionships of self-efficacy and the internal locus of control
with compliance in hemodialysis patients. Behav. Med.
2006; 32: 5–11.
Personality in hemodialysis patients
12. Christensen AJ, Smith TW. Personality and patient
adherence: correlates of the five-factor model in renal
dialysis. J. Behav. Med. 1995; 18: 305–313.
13. Wiebe JS, Christensen AJ. Health beliefs, personality,
and adherence in hemodialysis patients: an interactional
perspective. Ann. Behav. Med. 1997; 19: 30–35.
14. Moran PJ, Christensen AJ, Lawton WJ. Social support
and conscientiousness in hemodialysis adherence. Ann.
Behav. Med. 1997; 19: 333–338.
15. Koutsopoulou V, Theodosopoulou E, Vantsi E, Kotro-
siou E, Kostandinou V, Dounousi E. Personality dimen-
sions of haemodialysis patients related to initial renal
disease. EDTNA. ERCA. J. 2002; 28: 21–24.
16. Shimonaka Y, Nakazato K, Gondo Y, Takayama M.
NEO-PI-R, NEO-FFI Manual for the Japanese Version.
Tokyo Shinri Press, Tokyo, 1999.
17. Duberstein P, Sorensena S, Lynessa J et al. Personality is
associated with perceived health and functional status in
older primary care patients. Psychol. Aging 2003; 18:
25–37.
18. Terraccianoa A, McCraea R, Brantb L, Costa P. Hierar-
chical linear modeling analyses of the NEO-PI-R. Scales
in the Baltimore longitudinal study of aging. Psychol.
Aging 2005; 20: 493–506.
19. Nojima S, Kajimoto I, Hino Y, Matsumoto S, Miyatake
Y. Components of decision-making among hemodialysis
patients. J. Jpn. Acad. Nurs. Sci. 1997; 17: 22–31 (in
Japanese).
347
20. Pillmann F, Bloink R, Balzuweit S, Haring A, Marneros
A. Personality and social interactions in patients with
acute brief psychoses. J. Nerv. Ment. Dis. 2003; 191: 503–
508.
21. Rector NA, Hood K, Richter MA, Bagby RM. Obsessive-
compulsive disorder and the five-factor model of person-
ality. Behav. Res. Ther. 2002; 40: 1205–1219.
22. Aben I, Denollet J, Lousberg R, Verhey F,
Wojciechowski F, Honig A. Personality and vulnerability
to depression in stroke patients: a 1-year prospective
follow-up study. Stroke 2002; 33: 2391–2395.
23. Cohen NL, Ross EC, Bagby RM, Farvolden P, Kennedy
SH. The 5-factor model of personality and antidepressant
medication compliance. Can. J. Psychiatry 2004; 49: 106–
113.
24. Wilson RS, Mendes de Leon CF, Bienias JL, Evans DA,
Bennett DA. Personality and mortality in old age. J. Ger-
ontol. B. Psychol. Sci. Soc. Sci. 2004; 59: 110–116.
25. Cappeliez P, O’Rourke N. Profiles of reminiscence
among older adults: perceived stress, life attitudes, and
personality variables. Int. J. Aging Hum. Dev. 2002; 54:
255–266.
26. Watanabe T, Hiraga S, Saito T. The quality of life and the
mood state in hemodialysis patients. Jpn. J. Psychosom.
Med. 1998; 38: 339–345 (in Japanese).
27. Costa PT, Stone SV, McCrae RR, Dembroski TM,
Williams RB. Hostility, agreeableness-antagonism, and
coronary heart disease. Holistic Med. 1987; 2: 161–167.
© 2007 The Authors
Journal compilation © 2007 Folia Publishing Society