Key result
Women undergoing hemodialysis exhibit notably higher rates of depressive symptoms compared to men.
Why the study?
Depression is highly prevalent in individuals undergoing hemodialysis, but the related sex and gender characteristics in this population are not well known.
Systematic Review
This scoping review highlights that female individuals and women on hemodialysis experience notably higher rates of depressive symptoms compared to males/men, though sex and gender are often used interchangeably in the literature.
Answers are grounded in this paper and cite their sources.
May warrant targeted depression screening for women on hemodialysis; extends syntheses by noting sex-gender conflation in 76% of studies.
Purpose of Review: Depression and depressive symptoms are prevalent and disproportionally high among individuals undergoing hemodialysis. Depression has emerged as the most common mental health issue within the hemodialysis community. However, the characteristics related to sex and gender among individuals receiving hemodialysis and experiencing depression and depressive symptoms are not well known. The purpose of this review is to describe the characteristics of sex and/or gender in adults receiving hemodialysis and living with depression or depressive symptoms. Sources of Information: Electronic databases included Cochrane, Embase, Medline, CINAHL, and PsycINFO, when searching for peer-reviewed literature. Methods: Systematic searches were conducted to identify peer-reviewed literature related to the characteristics of sex and gender factors among people treated with hemodialysis worldwide. Two reviewers screened 4036 titles, abstracts, and 37 full texts. Discrepancies were resolved by these same reviewers. Data from the studies that met the inclusion criteria were extracted according to the study objectives; characteristics of sex and/or gender were further analyzed by similarities and differences. Key Findings: We identified 25 peer-reviewed articles that addressed the characteristics of sex and/or gender. Of the 25 articles, 7 reported gender differences, 4 reported gender similarities, 13 reported sex differences, and 1 reported sex similarities in individuals with depression or depressive symptoms treated with hemodialysis. We found more differences than similarities in sex and gender related to depression among individuals with kidney failure undergoing hemodialysis, with notably higher rates of depressive symptoms observed in female individuals (sex) and women (gender). However, findings alert us to the possibility that due to contextual influences, male individuals may express depressive symptoms in different ways. There was substantial heterogeneity among the included papers, with nearly half of the studies conducted in Asia. In 76% of the studies, sex and gender were used interchangeably without a clear distinction; we used the term or the intention of the term used by the authors in their studies to inform our analysis. Studies further lacked any representation of gender-diverse individuals. Limitations: It is possible that additional literature on depression in relation to the characteristics of sex and gender among adults undergoing home-based hemodialysis exists; our systematic search was limited to in-center and satellite settings. Our study primarily investigated populations in Asia. It is important to note that there may have been misclassification issues with the terms "sex" and "gender."
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Mharapara et al. (2025) conducted a systematic review in Depression and depressive symptoms in hemodialysis. Sex and gender characteristics was evaluated on Sex and gender differences in depression and depressive symptoms. Female individuals and women undergoing hemodialysis exhibited notably higher rates of depressive symptoms compared to males and men across 25 reviewed studies.
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