Background: Chronic renal failure is one among the chronic illness which due to persistence of the disease has various effects on the physiological, psychological and functional ability of the patient and his family. Although haemodialysis has become a highly safe medical procedure that significantly extended life of such patients, it is nevertheless a stressful and lengthy treatment process. The task of personal life care for such patients falls primarily on the family members. The caregiver is expected to aid in patient’s daily life activities resulting in increased physical and emotional burden. With the considerable level of burden involved the concept of resilience thus become crucial as they could function as protective factors. The current study aims to assess the level of caregiver burden and resilience in caregivers of haemodialysis patients.Methods: A cross sectional observational study was done in 120 caregivers of patients diagnosed as having ESRD on maintenance hemodialysis. Zarit Burden Interview was used for assessing caregiver’s burden. Brief Resilience Scale was used to assess caregiver’s resilience.Results: 35.8% of caregivers had severe caregiver burden while looking after dialysis patients while 45% of caregivers had moderate burden. Caregivers showed low resilience about 72.5% which displays poor problem solving and emotion-focused coping strategies.Conclusions: The study shows that more than 80% of caregivers suffered from moderate to severe burden and poor resilience among them would be a contributing factor. The study also shows that female caregivers were most affected. The burden was significantly higher in caregivers as the years spent on caregiving increased and more hours spent per day looking after the patients. Health-care providers need to address these concerns based on both patient- and caregiver-focused approaches, rather than only patient focused.

Objective To undertake a systematic review and meta-analysis of pharmacological interventions for depression in people with traumatic brain injury. Method Searches were undertaken for randomised controlled trials of pharmacological interventions in people with depression and traumatic brain injury. Searches were carried out as per our protocol and studies that fulfilled our inclusion criteria were included in the meta-analysis. Results Four studies were identified that fulfilled our inclusion criteria. Sertraline, desipramine, methylphenidate and modafinil were investigated in these studies. There were 72 participants in total in the intervention arm and 57 participants in the placebo arm. Meta-analysis showed favourable results for sertraline, desipramine and methylphenidate on outcomes measures for depressive symptoms. Only results for methylphenidate were statistically significant. Sertraline, methylphenidate and modafinil showed favourable results on quality of life indicators but results were not statistically significant. Sertraline showed favourable results on outcome measures for anxiety symptoms but results were not statistically significant. Conclusion Some pharmacological interventions appear to improve depressive symptoms, anxiety symptoms and quality of life in people with depression and traumatic brain injury. However, the evidence is limited. There is a paucity of evidence for the effectiveness of other pharmacological interventions used in depression in this particular patient group.

BACKGROUND The prevalence of chronic kidney disease (CKD) has steadily increased over the past few decades. Multiple factors including improvements in life expectancy and increasing prevalence of comorbid illness such as hypertension and diabetes have contributed to this. Most common form of treatment in CKD patients is haemodialysis. Depression and anxiety disorders are common psychological problem among haemodialysis patients. However, there is minimal literature on the prevalence of anxiety and depressive symptoms and their impact on patient's quality of life and treatment outcomes. Quality of life (QoL) is another neglected aspect of CKD care, as the available resources are often used to address the general medical needs. The current study aims to assess the prevalence of symptoms of depression and anxiety in patients of haemodialysis and the perceived quality of life in these patients. METHODS A cross sectional observational study was done in 120 haemodialysis patients after approval from Institutional Ethics Committee and after getting informed consent from patients. The study was done in the dialysis unit under Department of Nephrology, Travancore Medical College, Kollam. Patients were screened by a semi-structured questionnaire which includes the patients' socio-demographic data. Hospital Anxiety and Depression Scale (HADS) was used to assess severity of anxiety and depressive symptoms. The Quality of Life (QoL) was assessed using Kidney Disease Quality of Life questionnaire (KDQOL-36™), with higher scores indicating better quality of life. RESULTS The prevalence of anxiety symptoms in study sample is 64.2% and prevalence of depressive symptoms in study sample was found to be 37.5% which was significantly high. There was statistically significant association between anxiety and depressive symptoms with age of patients, gender, duration of dialysis and complication during dialysis. The five domains of KDQOL showed that mean scores of QoL in areas of mental and physical health along with effect of kidney disease on life and burden of having kidney disease were less indicating poor quality of life. Anxiety and depression were negatively correlated to all the domains of KDQOL indicating that anxiety and depressive symptoms worsened quality of life of dialysis patients. CONCLUSIONS Depressive and anxiety symptoms are significantly prevalent in patients undergoing maintenance haemodialysis which usually go un-addressed. Older patients and females were more at risk of developing depressive and anxiety symptoms. Longer periods of dialysis and complications during dialysis were also important contributors to depressive and anxiety symptoms. Quality of Life was poor in patients on dialysis, and symptoms of anxiety and depressive negatively impacted quality of life.