Assessment of Depression for Adult Patients with Hemodialysis

Hussein Hadi Atia,Amean A. Yasir,Khalida Mohammed Khuder
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Keywords : Assessment of Depression,Adult Patients,Hemodialysis
Medical Journal of Babylon  9:1 , 2014 doi:1812-156X-9-1
Published :2012


Background:-Hemodialysis is the most common method of dialysis. Hemodialysis is used for patients who are acute ill and require short-term dialysis (days to weeks) and for patients with End stage renal disease (ESRD) who require long-term or permanent therapy. A dialyzer (also referred to as an artificial kidney serves as a synthetic semi permeable membrane, replacing the renal glomeruli and tubules as the filter for the impaired kidneys. For patients with chronic renal failure, hemodialysis prevents death, although it does not cure renal disease and does not compensate for the loss of endocrine or metabolic activities of the kidneys. Treatment usually occurs three times a week for 3 to 4 hours per treatment. Patients receive chronic or maintenance dialysis when they require dialysis therapy for survival and control of uremic symptoms. The trend in managing End stage renal disease (ESRD) is to initiate treatment before the signs and symptom associated with uremia become severe. Methods:-A descriptive study was carried out of Baghdad Teaching Hospital and Surgical Specialties Teaching Hospital from 6\4\2010 to 1\7\2011. A purposive "non- probability" sample of (50) patient with hemodialysis with criteria of the sample (adult patients and 18 years and above).questionnaire form was constructed for the purpose of the study. Data were collected through the application of the questionnaire and interview technique. Validity of questionnaire was response through panel of (10) experts. Test- Retest reliability was determined through a computation of Pearson Correlations for the health problems assessment of depression scales (r=0.86). Data were analyzed through descriptive statistical approach (frequency, percentage and mean of score0 and inferential statistical approach (chi-square, and correlation coefficient). Results:-The findings of the study had revealed that most of patients with hemodialysis has mean age were (47.2) years and most of them from group (48-58) years (26%) and were males (64%) living in urban residence (94%), and they were married (88%). Most of them no read and write (22%) in the level of education with retired occupation (36%) and then barely sufficient (50%) for monthly income in spite of living in ownership house (78%). Conclusions:-The study concluded that most of the study sample who suffering from depression were (middle age, males, married, secondary graduate, housewives, urban residence, and live in renter house). Although all the items of depression scale among moderate and high severity. The study concluded that there is a significant association at ( P? 0.05) between depression and educational level only.


emodialysis is a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies (the other two being renal transplant; peritoneal dialysis) [1]. Psychiatric evaluation of depression in medically ill patients using DSM-III-R or Research Diagnostic Systems has not been validated for this population. Diagnosis of depression has been especially problematic in patients with end-stage renal disease (ESRD). The study found a 17.7% prevalence of RDC-defined minor depression and a 6.5%prevalence of major depression in 124 ESRD patients treated with hemodialysis [2]. Vegetative symptoms of depression were less useful for discriminating between those with and without depression than were the psychological symptoms of suicidal ideation, depressed mood, and discouragement [3]. Abstract loss of interest in normal daily activities you lose interest in or pleasure from activities that you used to enjoy. Depressed mood, you feel sad, helpless or hopeless, and may have crying spells [4]. Sleep disturbances, sleep too much or having problems sleeping, waking in the middle of the night or early in the morning and not being able to get back to sleep, and impaired thinking or concentration. Trouble concentrating or making decisions [5]. Problems with memory (difficulty with short term memory) changes in weight, and an increased or reduced appetite [6]. Fatigue or slowing of body movements, feel weariness an lack energy, feel as tired in the morning, and have trouble getting out of bed [7]. Feel like you re doing everything in slow motion or you may speak in a slow, monotonous tone. Low self-esteem, feel worthless, excessive guilt, pessimism, poor self-esteem, and self-criticism are all common. Agitation you may seem restless, agitated, irritable and easily annoyed, and difficulty controlling your temper [1].Physical complaints, such as gastrointestinal problems (indigestion, constipation or diarrhea), headache and backache. Many people with depression also have symptoms of anxiety [8]. Children, teens and older adults may react differently to depression. Kids may pretend to be sick, worry that a parent is going to die, perform poorly in school, and refuse to go to school, or exhibit behavioral problems [9]. Less interest in sex, thoughts of death, a persistent negative view of yourself, and your situation and future [10].

Materials and methods

Descriptive study was carried out through the present investigation to achieve the aim of the study starting from the 6\4\2010 to 1\ 7\2011.
The study was carried out of Baghdad Teaching Hospital and Surgical Specialties Teaching Hospital.
Purposive (non-probability) sample of (50) adult patients who were attending outpatient department for hemodialysis.
A questionnaire was designed and constructed by the researcher to measure the variables underlying the study.
The questionnaire consisted (2) parts; first general information (8) variables such as (age, gender, marital status, educational level, occupation, residence, monthly income, and type of house). Depression Scale it consisted (21) items these items rated and scored as (3 for always), (2 for sometime), and (1 for never).
Low score= less than 31.5
Moderate score= 31.5- 52.5
High score= 52.5 and above
No depression= Less than 42
Depression = 42 and more
Data were collected through the utilization of developed questionnaire and interview technique for adult patients with hemodialysis. The interview with each patient took approximately (15-20) minutes.
Data collection carried out during April to December 2010.
The data were analyzed through the application of descriptive data analysis approach [frequency, percentage, mean of score (less than 1.5= low, 1.5 2.5= moderate and 2.5 and above= high)] and inferential data analysis approach (Chi-squire and correlation coefficient).
The data were analyzed through the use of statistical package of social sciences (SPSS) version 10.0.


Table 1 distribution of demographic characteristics of (50) patient with hemodialysis This table revealed that the majority of age group were (48-58) years old with frequency 13(26%), and the mean of age were (47.2) year. The most of the study sample were male 32(64%), although, most of them were married 44(88%), and they are no read and write 11(22%). Table 2 distribution of demographic characteristics of (50) patient with hemodialysis This table revealed that the majority of the study sample were retired 18(36%), and most of them were living in urban residence and have barely sufficient in monthly income 25(50%) in spite of living in ownership house 39(78%). Most of the study samples have depression 38 (76%).Table 3 Mean of score for the items of depression This table shows that the high mean of score in items (9, 14, 15, 16, 18, 19, 20, and 21) and moderate on remaining items.


The results of the study revealed that the majority of age group were (48-58) years old with frequency 13(26%), and the mean of age were (47.2) year (Table 1). This result agrees with other study in Mostar Bosnia which stated that the patients on hemodialysis were aged from 28 to 77 year, with the mean age of 56.2 ± 13.4 years [11]. The most of the study sample were male 32(64%), although, most of them were married 44(88%) (Table1). This results agrees with other study in Spanish which indicated that men more than women (83 men and 69 women) receiving hemodialysis [12]. Another study reported that 88 patients receiving hemodialysis were 62 men and 26 women [13]. Although married patients showed a lower percentage of depression, the lower depression percentage among married patients may be due to psychosocial support of the spouses [13]. Regarding to the level of education most of the study sample were no read and write 11(22%) and retired 18 (36%) (Table1). This result agrees with other study which indicates that the patients with lower education level have inadequate coping patterns with hemodialysis that lead to depression [11]. The findings shows that the study sample were living in urban residence and have barely sufficient in monthly income 25 (50%) in spite of living in ownership house 39(78%) (Table 2). The decrease of depression accompanying an increase of avoidance-oriented stress coping was greater in patients with low income and in older patients than it was in the other patients [14]. The results indicated that the study samples were having highly level of depression 38 (76%). In addition, an assessment of war psych-trauma and its effects on the patients` depression levels was not carried out, although the recent war exerted strong effects on general population of the local community (Table 1 & 2). Depression is common and associated with decreased health-related quality of life and increased mortality in hemodialysis patients [5]. The study in Bosnia recorded significantly prevalence of depression in patients on chronic hemodialysis (51.8%). These results indicate that patients on hemodialysis have a significantly higher level of depression [11]. Nearly 65% of hemodialysis patients had a depressed mood in Southern Taiwan [15]. Co morbid depression occurred in 63% of hemodialysis patients [16]. The findings of the study shows that the high mean of score in items {9 (I want to cry), 14 (I can not work or accomplish anything at all), 15 (I am suffering from difficulty in sleep), 16 (I `m very tired and I could not do anything ), 18 (I have concerned because of health status), 19 (Lost my interest in sexual matters entire ) , 20 (Loss from my weight), and 21 (I`m thinking for death) } and moderate on remaining items (Table 3). Often chronic kidney disease on hemodialysis suffers from depression and loss of self-confidence [17]. Fatigue and depressive mood are the most significant symptoms experienced by patients with end-stage renal disease receiving hemodialysis in Southern Taiwan [15]. Sleep quality, sexual functioning, and cognitive functioning are quality of life dimensions impacted by daily hemodialysis [18]. Anemia and fatigue contribute to diminished physical and emotional well-being, lack of energy and drive and apathy [1]. Hemodialysis may be a risk factor for developing sleep disturbances [1]. Patients requiring long-term hemodialysis are often concerned about the unpredictability of the illness and the disruption of their lives. They often have financial problems, difficulty holding a job, waning sexual desire and impotence, depression from being chronically ill, and fear of dying. Younger patients worry about marriage, having children, and the burden that they bring to their families [1]. The results of the study indicated that there is no significant association between depression with (age, gender, marital status, occupation, monthly income, and house ownership) and there is a significant association between depressions with educational level (Table 4 &5). The decrease in depression accompanying the increase in task-oriented stress coping was greater in highly educated patients than it was in the other patients [14]. Presence of depression was not related to age or gender [13].




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