Prevalence and patterns of depression and anxiety in hemodialysis patients: A 12-month prospective study on incident and prevalent populations

• Published in: British journal of health psychology 2015-05, Vol.20 (2), p.374-395
• Main Authors: Ng, Hui Juan, Tan, Wei Jie, Mooppil, Nandakumar, Newman, Stanton, Griva, Konstadina
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Analysis of Variance; Anxiety; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; anxiety trajectory; Attitude to Health; Change agents; Clinical assessment; Comorbidity; Demography; depression trajectory; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Dialysis; Emotional distress; Emotional responses; Female; Hemodialysis; Hospitalization; Humans; Incidence; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; longitudinal; Male; Medical screening; Mental depression; Mental health; Middle Aged; Morbidity; Mortality; Perceived social support; Prevalence; Prospective Studies; Psychological aspects; Psychological distress; Quality of life; Quality of Life - psychology; Recovery; Renal Dialysis - psychology; Renal Dialysis - statistics & numerical data; Singapore - epidemiology; Social anxiety; Social interaction; Social resources; Social Support; Socioeconomic Factors; Stress, Psychological - epidemiology; Stress, Psychological - psychology; Surveys and Questionnaires; Symptoms; Variance analysis
• ISSN: 1359-107X; 2044-8287
• DOI: 10.1111/bjhp.12106

Objective Depression is common in dialysis patients and has been shown to be associated with higher morbidity and mortality, but little is known about the course of symptoms over time. The current study set up to explore group and individual patterns of change in symptoms of anxiety and depression within the hemodialysis population and to identify socio‐demographic, clinical, and psychological factors that may be associated with different trajectories of emotional distress. Methods A total of 159 hemodialysis patients (n = 42 incident and n = 117 prevalent) completed the Hospital Anxiety and Depression Scale and social support and symptoms subscales from the Kidney Disease Quality of Life (Short Form) on two occasions 12 months apart. Clinical cut‐offs were used to identify individual patterns of change in anxiety and depression symptoms across time, and analysis of variance (ANOVA) procedures were employed to establish potential correlates of these trajectories. Results Mean levels of anxiety and depression symptoms remained unchanged over 1 year with 44.7–54.1% of patients above cut‐off at both baseline and follow‐up. Individual‐level analyses showed that the course of symptoms does not follow a single trajectory. While most patients had either persistent symptoms of distress (39.6% and 31.8% for depression and anxiety, respectively) or no/low symptoms of distress (32.1% and 36.9% for depression and anxiety, respectively), a total of 12.7–18.5% patients either had new‐onset symptoms of depression/anxiety or symptoms diminishing over time. Patients with persisting or new‐onset symptoms of depression or anxiety reported reduced perceived social support and quality of social interaction compared to the subgroups with low depressive/anxious symptoms. Conclusion Different patterns of symptoms reflect heterogeneity in patients' emotional reactions and adjustment. More research is needed to identify patients at risk for emotional distress and to explore social support in the context of dialysis. Statement of contribution What is already known on this subject? Depression and poor mental health are common in hemodialysis patients and are associated with higher risk of hospitalization and death. Course of depression in incident hemodialysis patients is variable, but evidence on prevalent patients and course of symptoms of anxiety is largely lacking. What does this study add? Anxiety and depression remain undifferentiated over time with most patients reporting pers