Symptoms of Anxiety and Depression Among Patients on Haemodialysis and Their Correlation With Perceived Quality of Life- A Cross Sectional Study

Abstract

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.