Psychiatric comorbidity and quality of life in patients undergoing hemodialysis

Common mental disorders and associated factors among adult chronic kidney disease patients attending referral hospitals in Amhara Regional State

Common mental disorders (CMDs) are a wide term that includes disorders like depression, anxiety, and somatic manifestations. Chronic kidney disease (CKD) patients are at high risk of developing a common mental disorders, which leads to a lower survival rate, poor clinical outcome, longer hospitalization, increased health-care utilization, difficulty adhering to medications, an increased risk of initiation of dialysis, poor quality of life, and an increased risk of mortality. However, there is limited study done related to common mental disorders and associated factors among chronic kidney disease patients in Ethiopia. This study aimed to assess the prevalence of common mental disorders and associated factors among chronic kidney disease patients attending referral hospitals in Amhara Regional State. An institution-based cross-sectional study design was conducted at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals from January to April 2020. The study participants were selected using systematic random sampling techniques. Common mental disorders were assessed using the Self-Reporting Questionnaire-Falk Institute (SRQ-F) tool. Data were entered into Epi Data Version 3.0 then exported into STATA 14 for analysis. Both bivariable and multi-variable binary logistic regressions were done to identify factors associated with common mental disorders. In multivariable logistic regression analysis, variables with a p-value of ≤ 0.05 were declared as a statistically associated with common mental disorders. In this study, 424 CKD patients were included, with a response rate of 100%. Among screened CKD patients, 40.8% was positive for common mental disorders, with a 95% CI (36-45%). Independent predictors of common mental disorders among CKD patients were poor social support [(AOR 3.1, 95% CI (1.67-5.77)], family history of mental disorders, [AOR 3.6, 95% CI (1.12-11.8)], comorbidity [AOR 1.7, 95% CI (1.03-2.78)], being female [AOR 2.69, 95% CI (1.72-4.20)], and duration of CKD (AOR 3.5; 95% CI (2.28-5.54). Two out of five CKD patients screened for CMDs were found to be positive. Common mental disorders were more common among CKD patients with poor social support, a family history of mental disorders, comorbidity, being female, and the duration of CKD. Therefore, screening CKD patients for common mental disorders is recommended.

Alkuwaisi M, Zoromba MA. Prevalence of Depression and Its Associated Factors Among Hemodialysis Patients in Hodeida City, Yemen

Background

Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen.

Methods

A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05.

Results

The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035).

Conclusion

Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions.

Implications for practice

Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.

Quality of Life of Patients With Chronic Kidney Disease Under Maintenance Hemodialysis and Their Caregivers: A Cross-Sectional Study

BACKGROUND

Maintenance hemodialysis (MHD) prolongs the life of patients with end-stage chronic kidney disease (CKD), but this process can change their lifestyle, affecting their quality of life (QoL). Patients with MHD require their caregivers' assistance in daily management and repeated hospital visitation. This places a burden on caregivers affecting their QoL. Both patient and caregiver form a unit during the caregiving process. This study aims to compare and correlate the QoL of patients with CKD under MHD with their caregivers, considering their common familial and socioeconomic backgrounds.

METHODOLOGY

This is a cross-sectional, comparative study in the Hemodialysis Unit of Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Patients aged >14 years with CKD under MHD and caregivers staying with the patient at their resident place for a minimum of two months were included in the study. QoL of patients with CKD under MHD was compared with caregivers under different domains of the physical component summary (PCS) and mental component summary (MCS) scores using an SF-36 (Short form-36) health survey questionnaire. Data was collected and entered in Microsoft Excel 2010/Epi info version 7.2 and analyzed.

RESULTS

The overall QoL of caregivers was better than CKD patients under MHD in terms of both PCS score (48.13 vs. 35.36) and MCS score (48.11 vs. 43.25) and was statistically significant (p-value: <0.001) in both scores. The patient's QoL was not significantly correlated with the caregiver's PCS score (p-value: 0.635). Still, there was a significant correlation between QoL and MCS scores (p-value: 0.006). Similarly, caregivers had better QoL than CKD patients under MHD under all eight domains, which was statistically significant. No significant correlation was found between the frequency and duration of MHD with PCS and MCS scores of both patient and caregiver.

CONCLUSION

Overall, the physical and mental QoL of the caregiver was better than CKD patients under MHD. Further studies need to be conducted to assess the QoL of both groups compared to the healthy population to address the issue of hemodialysis patients and their caregivers.

Anxiety and Depression among Patients with Chronic Kidney Disease Undergoing Haemodialysis in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Chronic kidney disease is a global public health problem with psychological issues and other adverse issues like renal failure, cardiovascular disease, and premature deaths. This study aimed to find out the prevalence of anxiety and depression among patients with chronic kidney disease undergoing haemodialysis in a tertiary care centre.

Methods

A descriptive cross-sectional study was done among patients with chronic kidney disease undergoing haemodialysis in the Department of Medicine, Nephrology unit of a tertiary care centre from December 2020 to June 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 1712202003). The whole sampling method was used. The diagnosis of anxiety and depression was made using the Nepali version of the Hospital Anxiety and Depression Scale with a cut-off of ≥8 scores.

Results

Among 96 patients, the prevalence of anxiety was 66 (68.75%) and that of depression was 74 (77.08%) patients.

Conclusions

The prevalence of anxiety and depression was similar to other studies done in similar settings.

Keywords

anxiety; chronic kidney disease; depression; hemodialysis.

Depression, Adherence, and Functionality in Patients Undergoing Hemodialysis

Background 

Patients undergoing hemodialysis face multiple problems such as difficulties in performing daily activities, low functional capacity, non-adherence to the hemodialysis regimen, and depressive symptoms that lead to poor health outcomes. The present study aimed to assess the levels of depression, adherence, and functionality in patients undergoing hemodialysis, as well as the association between the above variables.

Materials and methods

In this cross-sectional study, 100 patients undergoing hemodialysis from a private hospital in Athens participated. Data were collected via the Zung Self-Rating Depression Scale, the Barthel Scale/Index, and the Greek Simplified Medication Adherence Questionnaire-Hemodialysis for the evaluation of patients’ depression, functionality, and adherence to hemodialysis regimen, respectively. In addition, sociodemographic and clinical characteristics were recorded. The study was conducted during the period of December 2020 to February 2021. IBM SPSS Statistics for Windows, Version 25.0 (Released 2017. IBM Corp., Armonk, New York) was used for the statistical analysis of the data. The statistical significance level was set up at 0.05.

Results

Of the patients, 50% scored < 38 (possible range 20-80) in the scale pof depression, and 25% of patients scored < 34. Regarding adherence, the median value was 7 (IQR: 7-7) while 77% scored 7 (possible range of 0-8). Regarding functionality, mild dependence (score 91-99) was referred by 77% of the participants, moderate dependence (score 61-90) by 17%, and severe dependence (score 21-60) was referred by 6% of the patients. A statistically significant negative association emerged between depression and functionality (r= -0.342, p=0.001) while no significant association arised between depression and adherence (r= 0.021,p=0.836) as well as between adherence and functionality (r = 0.078, p = 0.439). Statistical significantly higher scores of depression were seen in women (β = 3.65, p = 0.001) and elderly >70 years old (β = 3.51, CI=0.09-6.93, p = 0.044). Statistically significantly lower functionality were referred by patients >70 years old (β = -13.58, CI: -21.68-5.49, p = 0.001) and by patients with high depression score (β= -0.62, 95% CI: -1.06-0.20, p = 0.005).

Conclusion

Patients experienced moderate to low levels of depression and high levels of adherence and functionality. The higher the functionality scores, the lower the depression scores. Demographic characteristics, such as age and gender, seem to be significant predictors of depression and functionality.