How bad would it be? (May-05)

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For certain diseases, receiving treatment can disrupt daily life considerably. How would this disruption affect your happiness?

Think about your average mood during a typical week. How would you rate your average mood?

  • very pleasant
  • slightly pleasant
  • neutral
  • slightly unpleasant
  • very unpleasant
Now imagine you have end-stage renal disease, a condition in which your kidneys fail to perform their normal function of cleaning and filtering the blood. Treatment consists of a procedure called hemodialysis, in which your blood is filtered through a machine. You require treatment three times per week for about three hours each time. Discomfort is minor, and you can read, write, talk, eat, sleep, or watch TV during the treatment. Your lifestyle includes most normal activities, including work, exercise, and leisure; however, you feel fatigued if you miss treatment for several days. Also, you must follow a strict diet that involves reducing salt intake, consuming relatively little meat, and drinking only small amounts of fluids. Imagine, you have been on hemodialysis for a year.
Now imagine your average mood during a typical week if you had end-stage renal disease as described above. If you had end-stage renal disease, how do you think you would rate your average mood?
  • very pleasant
  • slightly pleasant
  • neutral
  • slightly unpleasant
  • very unpleasant

How do your answers compare?

The discrepancy between Patients and Non-patients

Past research has shown that there are serious health conditions that do not seem to be as badly experienced by the people living with them as healthy people would expect. Although the existence of this discrepancy is well established at this point, its cause is not. One possibility is that patients are exaggerating their well-being. They may be focusing on periods of positive mood even though they actually experience lengthy periods of negative mood. On the other hand, patients might be as happy as they report and healthy people might very much be overestimating the negative impact of the illness. A related explanation comes from evidence that healthy people tend to underestimate their own past moods, recalling negative times more readily than positive times. This would then make them more likely to also understate the well-being of other people as well, and this could contribute to the discrepancy.

Which explanation is correct?

Jason Riis, a researcher at the University of Michigan, teamed up with investigators from CBDSM and the University of Pennsylvania to conduct a study with the goal of finding out which of the above explanations is accountable for the discrepancy. To accomplish this, they set out to measure mood in two ways. One way is to ask individuals to estimate their average mood. The other way is to measure mood on a momentary basis, asking individuals at frequent intervals to indicate their mood at the moment, and then taking the average of these responses. This latter way of assessing mood is less influenced by biased recall than just asking subjects to estimate overall mood.

The investigators recruited 49 end-stage renal patients receiving hemodialysis treatment three times per week and 49 healthy controls who were matched to the patients on age, race, sex, and education. Subjects were first given an entry interview during which they estimated their average mood. They were then asked to carry around Palm Pilots for a week that beeped at random intervals, prompting them to indicate their mood at the moment. After carrying the Palm Pilots around for a week, subjects completed an exit interview that asked them to recall their average mood in the last week and to again estimate their average mood in general. Healthy subjects also estimated what they thought their average mood would be if they were a hemodialysis patient.

The investigators found that patients' average momentary moods were no lower than their estimated average mood, thus finding no evidence that patients exaggerate their mood. In fact, they failed to find any evidence that patients experience lower moods than healthy controls. In appears, then, that hemodialysis patients do largely adapt to their condition. On the other hand, healthy controls did rate that their average mood would be lower if they were homodialysis patients. Thus, the previously observed tendency of healthy people to underestimate the reported quality of life of people with various health conditions does seem to be due, in large part, to their misperception of the extent to which people can adapt to such conditions. In this study, healthy people also underestimated their own average mood. This could also account for some of the discrepancy, but the effect was not very large.

Why this is important

Ignorance of adaptation can have negative consequences for decision making. It can cause individuals to opt for unnecessarily risky surgeries and policymakers to invest in programs that have a minimal impact on people's well-being. This is not to say that research and treatment of kidney disease should not continue to be priorities, but in making difficult policy decisions, consideration of the moods experienced by patients may influence priorities between serious conditions such as, for example, paraplegia and depression. The results of this study suggest that policy makers should proceed with caition because healthy people's apparent exaggeration of the influence of illness on mood can lead to incorrect perceptions of how illness will influence quality of life.

Read the article:

Ignorance of hedonic adaptation to hemo-dialysis: a study using ecological momentary assessment.
Riis J, Loewenstein G, Baron J, Jepson C, Fagerlin A, Ubel PA. Journal of Experimental Psychology: General 2005;134:3-9.