Depression, Anxiety, and Stress in Patients Undergoing Hemodialysis: Assessment of Contributing Factors

Abstract: Background: The frequency of Chronic Kidney Disease (CKD) assessed worldwide is 13.4% (11.7-15.1%), and cases with ESKD demanding renal replacement therapy are calculated to be between 4.902 and 7.083 million. Several factors prompt anxiety and depression in hemodialysis cases. These include co-morbidities, frequent hospitalizations, habitual pain, sleep disturbances, chronic inflammation, increased fatigue, uremia, failure of family support, non-compliance to adjunctive therapeutics such as restrictions in diet and fluids, and dependence upon treatment and health professionals. Objective: To assess the frequency and contributing factors for incidents of depression, stress, and anxiety in hemodialysis patients. Materials and Methods: This is an observational, cross-sectional study conducted at the Karachi Institute of Kidney Diseases from February 2023 to March 2023, the obtained minimum sample size was 194. Data was collected with the help of DASS 10 questionnaire. The data was entered and analyzed by using Statistical Package of Social Sciences (SPSS) Version 22. Data significance was analyzed using Chi-Square test keeping P- value ≤0.05 as significant. Result: A total of 194 participants were recruited in the study, gender distribution recorded male dominance at 103 (53%) and females at 91 (46%). 139 (71.6%), the mean value of the length of dialysis was 15.4 ± 4.9 years while the mean days of dialysis were 2.7 ± 1.3. Moderate depression was reported in 101 (52%) of the study participants, while severe depression was reported in 25 (12.8%). Anxiety was reported as mild most frequently with 133 (68.5%) while stress was reported as mild in 48 (24.7%), moderate in 83 (42.7%), and severe in 63 (32.4%) with a p-value of 0.214. We identified a positive association of severe depression, anxiety, and stress with age ≤ 45 years in general, while participants from the upper middle class reported stress more frequently. Conclusion: This study concluded that compromised socio-economic status, young age, and higher prognosis rates are contributing factors for depression, anxiety, and stress in hemodialysis patients. Keywords: DASS, Depression, Hemodialysis, ESKD, Stress, Anxiety.