Depression in dialysis patients with end-stage kidney disease: investigating the role of psychosocial stressors, co-occurring medical conditions and demographic influences

BACKGROUND: Depression is common in end-stage kidney disease (ESKD) and is associated with poorer outcomes and higher mortality. However, treatment guidance is inconsistently applied. AIMS: To investigate screening measures, somatic symptoms, comorbidities and psychosocial and cultural influences on depression diagnosis in ESKD patients. METHOD: We recruited 300 people with ESKD receiving maintenance hospital haemodialysis in a deprived ethnically diverse area. We assessed depression using validated screening tools (Hamilton Depression Rating Scale and Patient Health Questionnaire 2) and a definitive ICD-10 diagnosis using a structured interview (Clinical Interview Schedule-Revised). We considered the role of adverse life events, co-occurring medical conditions, as well as age, sex and ethnicity, using descriptive statistics and multiple logistic regression. Ethnicity and sex were not significantly associated with moderate or severe depression. CONCLUSIONS: We found a lower prevalence of moderate to severe depression than commonly reported. Future research should consider careful diagnostic assessment, financial strain, loss events and physical co-occurring medical conditions such as diabetes.