розумінню впливу соціального середовища на здоров'я людини. УДК Brouchatskaya Elina Riga Anastasia-Valentini

Transcription

1 SECTION 2. SOCIAL PROBLEMS IN THE CONTEXT OF BRANCH SOCIOLOGYS. 2.9 SOCIOLOGY OF HEALTH. MEDICINE SOCIOLOGY/ РАЗДЕЛ 2. СОЦИАЛЬНЫЕ ПРОБЛЕМЫ В КОНТЕКСТЕ ОТРАСЛЕВЫХ СОЦИОЛОГИЙ. 2.9 СОЦИОЛОГИЯ ЗДОРОВЬЯ. СОЦИОЛОГИЯ МЕДИЦИНІЫ РОЗДІЛ 2. СОЦІАЛЬНІ ПРОБЛЕМИ В КОНТЕКСТІ ГАЛУЗЕВИХ СОЦІОЛОГІЙ. 2.9 СОЦІОЛОГІЯ ЗДОРОВ'Я. СОЦІОЛОГІЯ МЕДИЦИНИ УДК Brouchatskaya Elina Riga Anastasia-Valentini ACTION-RESEARCH IN SOCIAL-CLINICAL PSYCHOLOGY AND CLINICAL SOCIOLOGY: A CASE STUDY OF END-STAGE CHRONIC RENAL DISEASE IN PATIENTS REQUIRING HEMODIALYSIS. THE CASE OF CRETE. В статье представлены результаты исследования влияния социальных, географических, экономических и личностных характерискик на восприятие себя и чувства идентичности пациентов с последней терминальной стадией почечной недостаточности, нуждающихся в гемодиализе. Общий вывод, сделанный на основе анализа результатов является то, что социальные, географические, экономических и личностные факторы играют как положительную так и отрицательную роль в адаптации в ситуации хронических заболеваний. Как показали результаты настоящего исследования, этот фактор, лишь частичный показатель длинной цепи событий, эти события следует рассматривать в их взаимном сочетании, с тем чтобы содействовать пониманию влияния социальной среды на здоровье человека. Ключевые слова: хроническая болезнь почек; пол; локальность происхождения, профессия, образование; семейное положение; положительная или отрицательная адаптации к болезни. У статті представлені результати дослідження впливу соціальних, географічних, економічних та особистісних характеріскік на сприйняття себе і почуття ідентичності пацієнтів з останньою термінальною стадією ниркової недостатності, які потребують гемодіалізу. Загальний висновок, зроблений на основі аналізу результатів свідчить про те, що соціальні, географічні, економічних і особистісні фактори грають як позитивну так і негативну роль в адаптації в ситуації хронічних захворювань. Як показали результати цього дослідження, цей чинник, лише частковий показник довгого ланцюга подій, ці події слід розглядати в їхньому взаємному поєднанні, з тим щоб сприяти Brouchatskaya Elina - Doctor of Social Clinical Psychology University of Crete Riga Anastasia-Valentini - Professor of Social Clinical Psychology, University of Crete E. Brouchatskaya, 2010 Anastasia-Valentini Riga, розумінню впливу соціального середовища на здоров'я людини. Ключові слова: хронічна хвороба нирок, стать; локальність походження, професія, освіта; сімейний стан; позитивна чи негативна адаптація до хвороби In this paper we present the findings of an actionresearch programme regarding the effect of one s social, geographic and economic origins in the perception of self and sense of identity of patients suffering from end-stage renal disease requiring hemodialysis. The general conclusion reached by the analysis of the results is that one s social, geographic and economic origins play both a positive and a negative role in one s adaptation in the facts of a chronic illness. As demonstrated by the results of the present study, this factor is, in any case, only a partial indicator of a long chain of events; these events should be examined in their mutual combination in order to promote the understanding of the effect of the social environment on the course of a person s health. Key-words: Chronic Renal Disease; Gender; Locality of origin; Profession; Educational level; Family status; Positive or negative adaptation to the illness. Introduction In issues regarding health, many sociocultural differences are being observed which are related to a person s social and professional background. An illness may occur as a result of an interaction between biological and social factors, such as one s gender, profession, educational level, locality of origin, place of permanent residence, family status etc. (Nikolaidis & Benedetti, 1981; Ravanis, 1995; Link & Phelan, 1995). Behind all these lies each person s unique life history (Riga, 1997; Bartley et. al., 1998), with distinct existentially incorporated ways of functioning and reacting to the environment which consist a necessary prerequisite for causal mutuality and exchange (Williams, 1998). Each person has his or her personal history, his or her unique experiences; at the same time, each one is part of a collective history, since in fact everyone is part of a society and shares with the other members of this society its social representations, values and attitudes which determine one s future course (Zavalloni &Luis- Guerin, 1996). The way a person perceives his/herself relates to the existent, real or empirical self (i.e. how the person perceives oneself); to the desired or ideal self (i.e. how he/she would like to perceive his/herself); to the presented self (i.e. how one presents oneself to the others); and to the appropriate self (i.e. how

2 «SOCIOПРОСТІР: THE INTERDISCIPLINARY COLLECTION OF SCIENTIFIC WORKS ON SOCIOLOGY AND SOCIAL WORK», 1'10 «SOCIOПРОСТІР: МЕЖДИСЦИПЛИНАРНЫЙ СБОРНИК НАУЧНЫХ РАБОТ ПО СОЦИОЛОГИИ И СОЦИАЛЬНОЙ РАБОТЕ», 1'10 «SOCIOПРОСТІР: МІЖДИСЦИПЛІНАРНИЙ ЗБІРНИК НАУКОВИХ ПРАЦЬ З СОЦІОЛОГІЇ ТА СОЦІАЛЬНОЇ РОБОТИ», 1'10 oneself should be according to the current sociocultural facts) (Rosenberg, 1979; Higgins, 1987). A particularly determining factor regarding self-perception is one s physical or bodily characteristics, since they are directly projected into the Other s gaze, reminding us the extent in which we depend upon our body (Nettleton, 2002). The development of an image of the body is influenced by the attitudes and values of each particular culture, as well as by the views, values and attitudes of the person him/herself and the others in his/her life; actually, it is influenced by a person s personal and collective life history. During the last decades, the scientific literature tends to trace the causes of diseases and the individual s reaction to those diseases in elements of one s personality (Nettleton, 2002); as a matter of fact, one s personality is the outcome of one s personal and collective history (Zavalloni & Louis-Guerin, 1996). Adam and Ηerzlich (1999) argue that the effect of social conditions in the development of various illnesses is so powerful that certain social conditions and social strata are respectively connected to different diseases and different life expectancies. According to Ravanis (1995), in healthrelated issues, significant sociocultural variations are being observed, depending on a person s social and professional background. A categorization and differentiation between social groups based on socio-economic criteria (i.e. age, profession, income, education etc.) does not necessarily correspond to each group s social representations regarding issues like health (Agrafiotis, 2003). The perception and presentation of illness varies according to the patient s cultural environment. The factors which influence both the development of an illness and its perception by the patient are: a. the socio-economic environment which determines when and whether one will seek help for his/her problem; b. one s work status (i.e. whether one is working or is unemployed); c. one s social relationships and supporting network; d. social mobility (i.e. urbanization, industrialization) and; e. one s attitudes and beliefs regarding health and illness (Tselepis, 2000a). The aim of the present research was to investigate the effect of the social, geographic and economic background of patients suffering from end-stage chronic renal disease requiring hemodialysis regarding their self-perception after the 127 onset of the illness and their reaction to their health condition. Research The research sample consisted of 127 patients undergoing hemodialysis from the general area of Crete (prefectures of Chania, Rethymnon and Herakleion). The methodological framework was quantitative and the research tool used was a questionnaire with closed- and open-ended items. The variables gender, locality of origin, place of permanent residence, profession, educational level and family status were correlated with variables referring to the patients adaptation to the fact of the chronic illness. These latter variables were the patients feeling of being different from the others, their belief that they were being treated differently by the others, their change of character after the onset of CRD and their attitude toward the future (i.e. optimistic or pessimistic). The χ2 statistic was implemented in the analysis of the results so that the results might be applied to the general population of end-stage CRD patients requiring hemodialysis in the area of Crete. The results of the analysis were the following: No differences were observed between the two genders regarding the patients adaptation to the chronic illness The locality of origin seems to positively correlate with the optimistic or pessimistic patients attitude toward the future No positive correlation was found between the patients profession and the psychological consequences of the condition, nor between the profession and the participants attitude toward the future The patients educational level seems to correlate to their belief about being treated differently from the others after the onset of CRD There was no positive correlation between the patients family status and the psychological consequences of the disease, nor between the participants family status and their attitude toward the future Conclusions As demonstrated by the results of the present study, no differences have been observed between the two genders regarding the perception of self, the psychological consequences of CRD and the patients attitude toward the future. The chronic illness causes acute changes in the personal, social and professional life of the

3 SECTION 2. SOCIAL PROBLEMS IN THE CONTEXT OF BRANCH SOCIOLOGYS. 2.9 SOCIOLOGY OF HEALTH. MEDICINE SOCIOLOGY/ РАЗДЕЛ 2. СОЦИАЛЬНЫЕ ПРОБЛЕМЫ В КОНТЕКСТЕ ОТРАСЛЕВЫХ СОЦИОЛОГИЙ. 2.9 СОЦИОЛОГИЯ ЗДОРОВЬЯ. СОЦИОЛОГИЯ МЕДИЦИНІЫ РОЗДІЛ 2. СОЦІАЛЬНІ ПРОБЛЕМИ В КОНТЕКСТІ ГАЛУЗЕВИХ СОЦІОЛОГІЙ. 2.9 СОЦІОЛОГІЯ ЗДОРОВ'Я. СОЦІОЛОГІЯ МЕДИЦИНИ patient, often leading to the disorganization of one s life and the loss of one s sense of identity (Nettleton, 2002). Chronic renal disease patients demonstrate high levels of neuroticism (Ventura et al., 1989); other common disorders among them are depression, dementia and drug dependence (Kimmel et al., 1998; Kimmel, 2002). Some research suggests that women, compared to men, demonstrate greater vulnerability to psychopathological symptoms and especially depression (Kleftaras, 1998; Madianos, 2000; Pilgrim & Rogers, 2004). In addition, women appear unwilling to get ill, since their traditional role is to take care of the family; in this sense, the traditional role per se apparently has a protective function regarding physical illnesses in women (Nettleton, 2002; Pilgrim & Rogers, 2004). On the other hand, the family may be a source of anxiety for women, since it puts them in this role and thus, it influences their sense of identity. According to some research, married women are less adapted to the fact of the chromic illness, since they consider the loss of their abilities and skills greater than it actually is. Consequently, one would expect that the results of the present research would demonstrate a difference between the two genders, namely that women would present a more negative picture than men regarding their adaptation to the chronic illness, their perception of self and their attitude toward the future. On the other hand, the patients reaction to the illness depends on the extent that the chronic illness intervenes with and restrains one s functioning or constitutes an obstacle to the achievement of one s significant goals (Pedretti, 1990). In the professional field, women apparently suffer a lesser loss caused by CRD, since they are usually not employed in sectors requiring hard physical labour and should thus be abandoned after the onset of the illness (in this case the onset of endstage CRD). Of significant importance is the fact that the disease interferes with the men s basic values, namely with physical strength, power, authority, success, social life etc. (Chater & Gaster, 1997). Under this scope, one would expect a better reaction to the illness and greater optimism to be demonstrated by women, compared to men patients. The results of the present study do not confirm any of the two previous hypotheses. Actually, they suggest that there is no difference between the two genders regarding the patients perception of being different than the others (Table 1); their belief that they are being treated differently by the others (Table 2) and; in their character change after the onset of the disease (Table 3). The same holds for the patients attitude toward the future, where it seems that the possibility of an optimistic or pessimistic attitude is the same for both genders (Table 4). It seems that, despite the apparent differences between the two genders, a person s reaction to the fact of the chronic illness depends on one s personality which is formed based on one s social representations regarding one s role and the extent of one s contribution as a member of the society. Human behaviour can not be understood outside the natural environment within which it occurs; the dimensions of this environment reveal the collective and personal characteristics of its inhabitants (Madianos, 2000; Nettleton, 2002; Agrafiotis, 2003). The natural environment affects the human beings in both a physical and a social level (i.e. via the atmospheric pressure, the nutrition, the ways to deal with the environmental conditions, the conditions of collective labour, the models of behaviour etc.), and thus determines to a great extent their problem solving strategies. In this study we investigated the possible effect of a patient s geographic origin in one s reaction to end-stage CRD. More precisely, we investigated the possible correlation between the variables locality of origin and place of permanent residence with the variables indicating the patients reaction to the illness, that is feeling of being different than the others (Table 5); belief of being treated differently by the others (Table 6); change of character (Table 7); attitude toward the future (Table 8). The only positive correlation was found between the patients attitude toward the future and their locality of origin : patients that were born in villages with a population up to 500 people or towns with a population up to 2000 people, appear more likely to be pessimistic about the future (Table 8). This result, though, may be better attributed to the participants age group, since the majority of the participants who were born and still lived in cities and towns with a relatively small population, belonged to the age groups of and older than 66 (Broukhatska, 2008). As suggested by the research results, the factor locality of origin does not seem to significantly influence the reaction and adaptation of 128

4 «SOCIOПРОСТІР: THE INTERDISCIPLINARY COLLECTION OF SCIENTIFIC WORKS ON SOCIOLOGY AND SOCIAL WORK», 1'10 «SOCIOПРОСТІР: МЕЖДИСЦИПЛИНАРНЫЙ СБОРНИК НАУЧНЫХ РАБОТ ПО СОЦИОЛОГИИ И СОЦИАЛЬНОЙ РАБОТЕ», 1'10 «SOCIOПРОСТІР: МІЖДИСЦИПЛІНАРНИЙ ЗБІРНИК НАУКОВИХ ПРАЦЬ З СОЦІОЛОГІЇ ТА СОЦІАЛЬНОЇ РОБОТИ», 1'10 the patients to the chronic illness. We should also note that, since the variables locality of origin and place of permanent residence do not demonstrate significant differences neither to one another (Table 10), nor correlations to the afore mentioned variables, in the Appendix we include only the Tables referring to the correlations of the locality of origin variable. The analysis of the results of the possible effect of the factors profession and educational level in the reaction and adaptation of the patients to the chronic illness gave the following picture: in the patients of both genders, profession does not seem to positively correlate to the variables sense of being different than the others (Table 11); belief of being treated differently by the others (Table 12); change of character (Table 13); and attitude toward the future (Table 14). Therefore, we conclude that the reaction and adaptation to the chronic illness (in this case, end-stage chronic renal failure) does not seem to be affected by the patients profession. In the case of the possible effect of the patients educational level in their reaction to the incurable illness, it does not seem to correlate to the patients sense of being different than the others (Table 15); to their change of character after the onset of the illness (Table 16); nor to their attitude toward the future (Table 17). It probably effects the patients belief of being treated differently by the others (Table 18), after the onset of CRD. Actually, it is the patients with a higher or an academic educational level that tend to express their belief of being treated differently by the others after the onset of chronic renal failure. Eventhough the patients with a lower educational level express the same concern (we refer to patients who have graduated the primary school and consist the biggest group among the participants), the researchers consider remarkable the fact that the same result was found for the participants belonging to the higher and academic educational level groups. A possible interpretation of these results may involve the fact that among the lower social strata, people tend to attribute the event of an illness to one s fate and its causes to bad lack (Nikolaidis & Benedetti, 1981; Nettleton, 2002). Higher education contributes to a higher accessibility to information regarding the causes of diseases. Nevertheless, this information is often filled with oversimplified messages, which at the same time overemphasize one s own responsibility for the state of one s health (Nettleton, 2002). Maybe this is why the more educated patients, attributing the responsibility for the development of the illness to themselves tend to believe that the others, thinking in a similar way, treat them differently than they used to, since they consider the patients mainly responsible for their condition. The investigation of the possible effect of the patients family status to their adaptation to the chronic illness did not demonstrate a positive correlation with the variables sense of being different than the others (Table 19); belief of being treated differently by the others (Table 20); change of character (Table 21); and attitude toward the future (Table 22). Thus, the possibility for a patient to mention or not his/her sense of being different than the others ; his/her belief of being treated differently by the others ; his/her change of character after the onset of the illness; his/her optimistic or pessimistic attitude toward the future, is expected to be found equal among single, married and widowed patients alike. It should be noted, however, that the sample of the present study was derived from the population of CRD patients in Crete, where family- even extended family- ties remain very strong and consist a characteristic element of the island s culture. Under this scope, the conclusion reached is that in a person s reaction to illness, one s family may be both a source of support and a source of anxiety (Nettleton, 2002). We consider important to remind that the analysis of the results of the present study was conducted using the χ2 statistic. This reminding is significant, since the morphological (proportional) analysis of the participants sample may differ from the χ2 analysis; a proportional analysis would provide with an initial general picture of the situation, but it would not permit for the generalization of the results to the general population. Thus, we believe that the present study brings forward an innovation in the investigation of the effect of the social, geographic and economic factors in a person s adaptation to chronic illness. The general conclusion emerging by the analysis of the research results is that there is no linear relation between a person s reaction to suffering from a physical disorder and to the factors relating to one s social, geographic and economic background; these factors may have both a positive and a negative effect in one s adaptation to chronic illness. Apparently, this adaptation depends to a greater extent on one s personality (Molnar, 1989; 129

5 SECTION 2. SOCIAL PROBLEMS IN THE CONTEXT OF BRANCH SOCIOLOGYS. 2.9 SOCIOLOGY OF HEALTH. MEDICINE SOCIOLOGY/ РАЗДЕЛ 2. СОЦИАЛЬНЫЕ ПРОБЛЕМЫ В КОНТЕКСТЕ ОТРАСЛЕВЫХ СОЦИОЛОГИЙ. 2.9 СОЦИОЛОГИЯ ЗДОРОВЬЯ. СОЦИОЛОГИЯ МЕДИЦИНІЫ РОЗДІЛ 2. СОЦІАЛЬНІ ПРОБЛЕМИ В КОНТЕКСТІ ГАЛУЗЕВИХ СОЦІОЛОГІЙ. 2.9 СОЦІОЛОГІЯ ЗДОРОВ'Я. СОЦІОЛОГІЯ МЕДИЦИНИ Trieschmann,1989). Personality, though, is being formed in a given society, according to the social representations and the personal experiences which relate to one s background (social, geographic and economic). There is no objective reality, but many subjective ones (Lipowatz, 1994), in which a person s history, both social and private, holds the primary part and in order for the effect of an illness to the person, as well as one s adaptation to it, to be understood there is the need of a non-oversimplified linear correlation between certain factors and the patient s reaction, but of a holistic investigation of one s psycho-social identity, as examined by the Ego-Ecological model of Zavalloni and Louis- Guerin (1996). APPENDIX Table 1. Gender and sense of being different than the others Chi-Square 2,334 Df 1 Exact Sig.,134 Table 2. Gender and belief of being treated differently by the others Chi-Square,258 Df 1 Exact Sig.,656 Table 3. Gender and change of character after the onset of CRD Chi-Square,878 Df 1 Exact Sig.,445 Table 4. Gender and attitude toward the future Chi-Square,149 Df 1 Exact Sig.,847 Table 5. Locality of origin and sense of being different than the others Chi-Square 8,083 Monte Carlo Sig.,158 Table 6. Locality of origin and belief of being treated differently by the others Chi-Square 5,046 Monte Carlo Sig.,423 Table 7. Locality of origin and change of character after the onset of CRD Chi-Square 2,344 Monte Carlo Sig.,815 Table 8. Locality of origin and attitude toward the future Chi-Square 12,939 Monte Carlo Sig.,020 Table of frequencies of the correlation between patients optimism or pessimism toward the future and their locality of origin LOCALITY OF ORINIG OPTIMISM Yes No Observed Expected ,5 11,2 4,5 8,4 7,9 9,5 Difference -4,5-4,2,5 4,6 1,1 2,5 Observed Expected ,5 8,8 3,5 6,6 6,1 7,5 - - Difference 4,5 4,2 -,5 4,6 1,1 1. Village with population up to Village or town with population Town with population Town with population City with population City with population over Table 9. Patients age Chi-Square 73,268 Asymp. Sig.,000 Monte Carlo Sig ,5 130 Table of frequencies of patients age

6 «SOCIOПРОСТІР: THE INTERDISCIPLINARY COLLECTION OF SCIENTIFIC WORKS ON SOCIOLOGY AND SOCIAL WORK», 1'10 «SOCIOПРОСТІР: МЕЖДИСЦИПЛИНАРНЫЙ СБОРНИК НАУЧНЫХ РАБОТ ПО СОЦИОЛОГИИ И СОЦИАЛЬНОЙ РАБОТЕ», 1'10 «SOCIOПРОСТІР: МІЖДИСЦИПЛІНАРНИЙ ЗБІРНИК НАУКОВИХ ПРАЦЬ З СОЦІОЛОГІЇ ТА СОЦІАЛЬНОЇ РОБОТИ», 1'10 Observed Expected Difference ,2-18, ,2-14, ,2-9, ,2 9, ,2 2, ,2 28,8 1= years 2= years 3= years 4= years 5= years 6= more than 65 years Table 10. Correlation between locality of origin and place of permanent residence Table 12. Profession and belief of being treated differently by the others Chi-Square 14,927 Df 10 Monte Carlo Sig.,127 Table 13. Profession and change of character after the onset of CRD Chi-Square 9,896 Df 10 Monte Carlo Sig.,469 Table 11. Profession and sense of being different than the others Chi-Square 7,489 Df 10 Monte Carlo Sig.,

7 SECTION 2. SOCIAL PROBLEMS IN THE CONTEXT OF BRANCH SOCIOLOGYS. 2.9 SOCIOLOGY OF HEALTH. MEDICINE SOCIOLOGY/ РАЗДЕЛ 2. СОЦИАЛЬНЫЕ ПРОБЛЕМЫ В КОНТЕКСТЕ ОТРАСЛЕВЫХ СОЦИОЛОГИЙ. 2.9 СОЦИОЛОГИЯ ЗДОРОВЬЯ. СОЦИОЛОГИЯ МЕДИЦИНІЫ РОЗДІЛ 2. СОЦІАЛЬНІ ПРОБЛЕМИ В КОНТЕКСТІ ГАЛУЗЕВИХ СОЦІОЛОГІЙ. 2.9 СОЦІОЛОГІЯ ЗДОРОВ'Я. СОЦІОЛОГІЯ МЕДИЦИНИ Table 14. Profession and attitude toward the future Chi-Square 9,804 Df 10 Monte Carlo Sig.,478 Table 15. Educational level and sense of being different than the others Chi-Square 6,924 Df 8 Monte Carlo Sig.,581 Table 16. Educational level and belief of being treated differently by the others Chi-Square 17,639 Df 8 Monte Carlo Sig.,022 Table of frequencies of the correlation between the patients belief of being treated differently after the onset of CRD and their educational level SENSE OF BEING TREATED DIFFERENTLY Observed YES Expected NO EDUCATIONAL LEVEL ,1 11,8 3,3,7 1,6 1,3,2,9 3,1 Difference -2,1-1,8-1,3,3,4 Observed Expected - 1,3,8 2,1 2, ,9 41,2 11,7 2,3 5,4 4,7,8 3,1 10,9 Difference 2,1 1,8 1,3 -,3 -,4 1,3 -,8-2,1-2,9 Table 18. Educational level and attitude toward the future Chi-Square 5,767 Df 8 Monte Carlo Sig.,719 Table 19. Family status and sense of being different than the others Chi-Square 2,361 Df 3 Monte Carlo Sig.,526 Table 20. Family status and belief of being treated differently by the others Chi-Square 5,782 Df 3 Monte Carlo Sig.,102 Table 21. Family status and change of character after the onset of CRD Chi-Square 7,028 Df 3 Monte Carlo Sig.,065 Table 22. Family status and attitude toward the future Chi-Square 5,839 Df 3 Monte Carlo Sig., Illiterate- a few elementary school grades; 2. Elementary school graduate; 3. Completion of some high-school grades (old high school/ six grades); 4. High-school graduate (new high-school/ 3 grades); 5. Lyceum graduate; 6. Old high-school graduate; 7. Technical school graduate; 8. Polytechnic graduate; 9. University graduate Table 17. Educational level and change of character after the onset of CRD Chi-Square 10,710 Df 8 Monte Carlo Sig.,

8 «SOCIOПРОСТІР: THE INTERDISCIPLINARY COLLECTION OF SCIENTIFIC WORKS ON SOCIOLOGY AND SOCIAL WORK», 1'10 «SOCIOПРОСТІР: МЕЖДИСЦИПЛИНАРНЫЙ СБОРНИК НАУЧНЫХ РАБОТ ПО СОЦИОЛОГИИ И СОЦИАЛЬНОЙ РАБОТЕ», 1'10 «SOCIOПРОСТІР: МІЖДИСЦИПЛІНАРНИЙ ЗБІРНИК НАУКОВИХ ПРАЦЬ З СОЦІОЛОГІЇ ТА СОЦІАЛЬНОЇ РОБОТИ», 1'10 BIBLIOGRAPHY Adam, P. H., & Herzlich, C. L. (1999). Sociology of Illness and Medicine. Patras: Greek Open University. Agrafiotis, D. (2003). Health, Illness, Society, Places and Ways of Entwining. Athens: Tipothito Publications- G. Dardanos. Bartley, M., Blane, D. & Davey-Smith, G. (1998). Beyond the Black Report. Sociology of Health and Illness, 20, 5. Broukhatska, Ε., Riga, Α., V. (2007). The psychosocial identity of patients with End-Stage Chronic Renal Failure: The effect of the parental models. 11 th Panhellenic Conference of Psychological Research, Rethymnon. Chater, K. & Gaster, R. (1997). The Myth of Equality. Athens: Fitrakis Publications. Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect. Psychological Reviews, 94, Zavalloni, M., & Louis-Guerin, C. (1996). Social Identity and Consciousness : Intoduction to Ego-Ecology. Athens: Ellinika Grammata. Kimmel, P. L. (2002). Depression in Patients with Chronic Renal Disease. Journal of Psychosomatic Research, 53, 4, Kimmel, P. L., Thamer, M., Richard, C. M., & Ray, F. (1998). Psychiatric Illness in Patients with End-Stage Renal Disease. The American Journal of Medicine, 105, 3, Κleftaras, G. (1998). Depression Today. Athens: Ellinika Grammata. Link, B. R., Phelan, J. (1995). Social Conditions as Fundamental Causes of Disease. Journal of Health and Social Behavior. No Lipowatz, Th. (1994). The Psychopathology of the Politician. Athens: Odysseas. Madianos, Μ. (2000) Introduction to Community Psychiatry. Athens: Kastaniotis. Molnar, G. E. (1989). The influence of psychosocial factors on personality development and emotional health in children with cerebral palsy and spina bifida. In B. W. Hellr, L. M. Flohr & L. S. Zegans (Eds.). Psychosocial interventions with physically disabled persons (pp ). London: Jessica Kingsley. Nettleton, S. (2002). Sociology of health and illness. Athens: Tipothito. Νikolaidis, D., & Bennedetti, G. (1981). Psychosomatic Medicine. Thessaloniki: Kyriakidis Bros. Pedretti, L. W. (1990). Psychological aspects of physical dysfunction. In L. W. Pedretti & B. Roltan (Eds). Occupational therapy: Practice skills for physical dysfunction (3 rd ed.). Baltimor: Mosby. Pilgrim, D., & Rogers, A. (2004). Sociology and mental health and illness. Athens: Tipothito. Ravanis, Ch. (1995). Society and Health. In Potamianos, G. Α. (ed.). Essays in Health Psychology. Athens: Ellinika Grammata. Riga, Α. V. (1997). Social Representations and Psycho-social Identity. Athens: Despoina Mavromati. Rosenberg, M. (1979). Conceiving the self. New York: Basic Books. Trieschmann, R. B. (1985). Psychological adjustment to spinal cord injury. In B. W. Heller, L. M. Flohr & L. S. Zegans (Eds.). Psychosocial interventions with physically disabled persons (pp ). London: Jessica Kingsley. Τselepis, Ch. (2000α). Social and Cultural Factors in the Prevention and the Experience of Illness. In Μantis, P., & Τselepis, Ch. (eds.). Sociological and Psychological Approach to the Hospitals and Health Care Services. (vol. A). Patras: Greek Open University. Ventura, M. C., Gonzalez, R., Alarcon, A., Morro, A., & Llabres, E. (1989). Chronic hemodialysis and personality. [ d=retrieve&db=pubmed&list_uids= &dopt =Abstrac.] Williams, S. J. (1998). Capitalising on Emotions? Rethinking the Inequalities in Health Debate. Sociology, 32,