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Perceived availability or receipt of tangible or instrumental social support has generally been associated with favorable outcomes in kidney transplant recipients, yet there has been insufficient attention in the literature to other social relationship processes beyond support that may contribute to mental and physical health. The overall objective of the current study was to examine whether specific dimensions of relationship quality, such as emotional closeness, sexual relations, support transactions, respect/acceptance, and conflict/negative communication, within the context of a close interpersonal relationship, were associated with psychosocial and medical outcomes in kidney transplant recipients when accounting for the effects of global social support. Participants had received a living or deceased donor kidney transplant and were 6 months - 5 years post-surgery at the time of enrollment in the study. A total of 93 participants completed self-report measures and a semi-structured clinical interview via telephone that assessed each of the aforementioned dimensions with regard to a specified relationship. A subsample of 67 participants were married or involved in a committed dating relationship and responded to interview questions with their partner in mind; the remaining participants selected the person to whom they felt closest over the preceding 6 months (e.g., friend, sibling, parent).
Structural equation modeling and linear regression were used to analyze the data. Results suggested that the distinct yet highly correlated dimensions reflected an underlying 'relationship quality' construct. Poorer relationship quality was associated with increased symptoms of depression, decreased feelings of well-being, and worse mental health-related quality of life for both the full sample and the subsample of participants in a romantic relationship. The path between relationship quality and depression remained significant for romantic relationship participants when global social support was included in the model, but global social support was more strongly associated with depression, well-being, and health-related quality of life for all participants. Relationship quality was not associated with adherence or graft function in this sample. However, interesting interaction effects were found, such that high conflict and lack of emotional intimacy were more strongly associated with poorer self-reported adherence in women. In addition, women who reported higher conflict in their relationship also endorsed increased depression, decreased well-being, and worse mental health-related functioning compared to men. These findings are consistent with previous research that has cited the importance of global social support for patients who have received a kidney transplant. The present study also provides novel evidence that other dimensions of relationship quality contribute to outcomes in this population. A comprehensive assessment of recipients' close relationships throughout the transplant process, particularly of conflict and emotional intimacy in women, would allow clinicians to recommend psychosocial interventions that could improve patient outcomes.