Depression and Anxiety in Urban Hemodialysis Patients

Abstract

Depression is well established as a prevalent mental health problem for people with ESRD and is associated with morbidity and mortality. However, depression in this population remains difficult to assess and is undertreated. Current estimates suggest a 20 to 30% prevalence of depression that meets diagnostic criteria in this population. The extent of other psychopathology in patients with ESRD is largely unknown. The aim of this study was to expand the research on psychiatric complications of ESRD and examine the prevalence of a broad range of psychopathology in an urban hemodialysis center and their impact on quality of life. With the use of a clinician-administered semistructured interview in this randomly selected sample of 70 predominately black patients, >70% were found to have a psychiatric diagnosis. Twenty-nine percent had a current depressive disorder: 20% had major depression, and 9% had a diagnosis of dysthymia or depression not otherwise specified. Twenty-seven percent had a current major anxiety disorder. A current substance abuse diagnosis was found in 19%, and 10% had a psychotic disorder. The mean Beck Depression Inventory score was 12.1 ؎ 9.8. Only 13% reported being in current treatment by a mental health provider, and only 5% reported being prescribed psychiatric medication by their physician. A total of 7.1% had compound depression or depression coexistent with another psychiatric disorder. The construct of depression was also disentangled from the somatic effects of poor medical health by demonstrating a unique relationship between depressive affect and depression diagnosis, independent of health status. This study also suggests the utility of cognitive variables as a meaningful way of understanding the differences between patients who have ESRD with clinical depression or other diagnoses and those who have no psychiatric comorbidity. The findings of both concurrent and isolated anxiety suggest that the prevalence of psychopathology in patients with ESRD might be higher than previously expected, and the disorders may need to be treated independently. In addition, the data suggest that cognitive behavioral therapeutic techniques may be especially advantageous in this population of patients who are treated with many medications.

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

“…The KDQOL has been widely used in hemodialysis patients. 11,13,28,45,46 The summary composite score is reported.…”

“…[1][2][3][4][5][6][7][8][9][10] Depression in ESRD patients has received much scientific attention and has been associated with lower quality of life (QOL), [11][12][13] decreased adherence to the dialysis presciption, [14][15][16] greater medical comorbidity, and decreased survival. [17][18][19][20][21] It is unclear whether depression has a direct causal role in poor outcomes associated with ESRD or if depression is rather a marker of increased disease comorbidity and illness severity.…”

Quality of life and well‐being of people receiving haemodialysis treatment in Scotland: A cross‐sectional survey

“…Psychological problems also include stress, anxiety, uncertainty and depression (Kimmel, 2005;Finkelstein et al, 2008). Evidence also suggests that the rate of patients diagnosed with a classified psychiatric disorder, such as depression, dementia and schizophrenia, in the ESRD population is substantially higher than that observed in other chronic medical conditions (Kimmel et al, 2002;Cukor et al, 2007). Depression is a common psychological challenge among the dialysis population and is generally linked to increased hospitalization and other complications including higher mortality (Kimmel et al, 2002;Gencoz and Astan, 2006;Finkelstein et al, 2008;Cengic and Resic, 2010).…”

“…Patients with ESRD experience many psychological problems such as depression, anxiety, uncertainty and dependency on the dialysis machine and the nursing staff (White and Grenyer 1999;Kimmel et al, 2003;Patel et al, 2005;Cukor et al 2007;Cengic and Resic, 2010). Evidence from four studies (see Table 3.5) suggests that the way in which spirituality/religion positively impacts on patients" lives is by helping them to cope and adjust to their psychological problems and by empowering them to accept their treatment and feel stronger in the face of illness.…”

“…Patients with ESRD undergoing HD treatment may experience many physiological problems such as uremia, joint pain and cardiovascular complications (Gilbar et al, 2005), and may also experience a wide range of multiple and radical lifestyle changes that affect their QOL (Covic et al, 2004;Molsted et al, 2004;Kring and Crane, 2009;Cengic and Resic, 2010) and their social and psychological well-being (White and Grenyer, 1999;Weisbord et al, 2003;Tsay and Hung, 2004;Cukor et al, 2007;Yong et al, 2009). …”