Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: a cross-sectional study

Abstract

Background In 2020, Lebanon has witnessed its worst economic crisis, exacerbated by the COVID-19 pandemic and a massive explosion of its capital. Amidst these stressors, this study aims at assessing the prevalence of depression, anxiety, suicidality, post-traumatic stress disorder (PTSD) and cognitive impairment in patients undergoing hemodialysis in an academic hospital destroyed by the explosion. Methods This cross-sectional study conducted 6 months after the blast included adults on hemodialysis, with no previous diagnoses of dementia or intellectual disability. It explores prevalence rates of psychiatric disorders, in addition to other medical and psychosocial variables such as frailty, malnutrition, sarcopenia, quality of life and religiosity. Results Forty two patients (mean age 66.1; SD: 11.2 years) undergoing hemodialysis for 6.12 years (SD:7.22 years) were included. Anxiety and depression rates reached 54.8% and 57.1% using cut-offs of 6 and 7 respectively on the Hospital Anxiety and Depression rating Scale. 9.5% of the patients reported being in the hospital at the time of the blast and 7.1% reported being injured. 33.3% screened positively for PTSD using a cut-off of 23 on the PCL-5. 26.2% had passive death wishes and 7.1% had suicide plans, however no one had attempted it. 23.8% were found cognitively impaired as shown by the Mini-Cog (<3). Around two-third of participants were moderately to severely malnourished per the GLIM criteria. One third suffered from frailty, according to the FRAIL screening tool. Around 60% suffered from sarcopenia, based on handgrip strength measures. These findings contrast with “acceptable to good” quality of life subjectively reported by participants on the Short Form 36 (SF-36) Health Survey. While one-third of participants participated in organizational religious activities, 88% reported significant subjective meaning of religion in their heart. Conclusions Rates of depression, anxiety, PTSD, suicidality, and cognitive impairment were found to be alarming in the setting of an urban dialysis unit following a major explosion. Psychiatric disorders were found to be compounded with increased prevalence of malnutrition, frailty, and sarcopenia. These findings urge healthcare providers to implement early diagnostic and intervention strategies to improve both mental and physical wellbeing of this vulnerable population, in similar settings.

Depression and death anxiety among patients undergoing hemodialysis during the COVID-19 pandemic in Palestine: a cross sectional study

“…The current study found that during COVID-19 pandemic, hemodialysis patients in Palestine had high levels of death anxiety and depressive symptoms as 69.8% of the sample reported death anxiety, and 66.2% reported depressive symptoms. Similarly, Ghiasi et al ( 25 ) found that 60.4% of the patients had high levels of death anxiety in Iran and in Lebanon, Khoury et al ( 45 ) reported a high rate of depression in patients on hemodialysis (57.1%). In addition, Duru ( 46 ) revealed that rates of depression were significantly higher both before and after COVID-19 pandemic in Turkey (63.1% vs. 75.0% as overall, and 19.0% vs. 33.3% for moderate-to-severe depression).…”

“…In addition, Duru ( 46 ) revealed that rates of depression were significantly higher both before and after COVID-19 pandemic in Turkey (63.1% vs. 75.0% as overall, and 19.0% vs. 33.3% for moderate-to-severe depression). The Beck Depression Inventory scale and repeated exposure to traumatic war-zone conflicts or events have been suggested as possible explanations for the higher rates in these studies ( 45 ). Therefore, it is critical to assess depression and death anxiety in these patients because they have been linked to poor survival rates, a high risk of suicidal ideation, and non-adherence to therapy ( 47–49 ).…”

Neuronal damage and inflammatory biomarkers are associated with the affective and chronic fatigue-like symptoms due to end-stage renal disease

“…In association with the biochemical changes, ESRD patients frequently experience physiosomatic symptoms, including chronic fatigue, fibromyalgia, muscular pain, insomnia, headache, cognitive impairments, and affective symptoms, including depression and anxiety (Cohen and Kimmel, 2018, Savitha et al, 2020, Elzeiny and El-Emary, 2023, Ibrahim et al, 2023, Semaan et al, 2018, Qawaqzeh et al, 2023, Khoury et al, 2023, Burdelis and Cruz, 2023, Molfino et al, 2023, Asad et al, 2023. Previous studies showed a high incidence of chronic fatigue (42-89%) and depressive or/and anxiety symptoms (around 50%) in chronic renal disease (Kim et al, 2012, Yoong et al, 2017 (Artom et al, 2014).…”

Quantification of Epistemic Capacity and Physical Frailty in Chronic Kidney Disease: Koch’s Disease Co-infection

“…The cognition and memory, psychological, and physical aspects of the quality of life of these patients deteriorate at an alarming rate [ 4 , 5 ]. Some hemodialysis patients develop dementia, anxiety, depression, and suicidal tendencies [ 6 ]. Furthermore, kidney function and cognitive power decrease considerably after 50 years of age [ 7 , 8 ].…”