Prevalence and risk factors associated with the severity of depression in patients with end-stage renal disease undergoing haemodialysis in southern Algeria.
Abstract
SUMMARY
Introduction: The management of patients suffering from end-stage chronic renal failure on haemodialysis is a major public health issue. Haemodialysis patients face a number of challenges: social, relational, family, financial, and psychological distress, of which depression is the main psychiatric condition described in this population.
High prevalence of depression in haemodialysis patients, which is underestimated, unrecognised and undiagnosed, represents a risk removed by non-compliance with treatment, indirectly responsible for an increase in morbidity and mortality in these patients.the severe nature of depression leads the patient to commit suicide, increases the potential for mortality and reduces quality of life.It is an additional burden for haemodialysis patients. Diagnosis and early detection of depression and its management is considered an indicator of quality of life .In Algeria, there is little data on depression in chronic haemodialysis patients, although it is the main psychiatric manifestation described in this population.We conducted this study in order to help improve the management of haemodialysis patients and improve their quality of life.. The aim of our study was: to assess the prevalence of depression and the clinical and epidemiological characteristics of this depression in haemodialysis patients in the EPHs of Laghouat, and to assess its severity using a Hamilton psychometric scale. And to look for factors associated with the severity of depression in patients with chronic renal failure undergoing haemodialysis.
Patients and Methods: This is a prospective cross-sectional descriptive study of patients with end-stage chronic kidney disease undergoing haemodialysis. From 13 July 2021 to 14 July 2022, a period of 12 months with a diagnosis of EDC, based on the DSM-5 diagnostic criteria.
Results and Discussion: A total of 379 patients were treated in the four haemodialysis centres in the wilaya of Laghouat during the study period. Of these, 289 met the inclusion criteria; 57.1% were men and 42.9% women, corresponding to a sex ratio of 1.33 with an average age of 52.38± 17.13 years, ranging from 18 to 91 years; the average duration of haemodialysis was 8 years and 2 months and 4 days; 56% had an average standard of living, 58.1% had completed their primary education, 56.1% were married, however kidney disease limited their activities, most of the patients (90%) had no activities, most of them (74.7% had undergone haemodialysis treatment for more than 5 years, the majority (69.6%) were less than 50 km from the haemodialysis centre to their home, almost all (90%) had received social support and 58.1% lived in an urban environment, 46% had comorbidities such as diabetes and hypertension, evenly distributed. In addition, the majority (58%) had a fistula as their vascular approach, 92% had regular sessions 3 times a week and 56.7% had frequent dialysis incidents. The prevalence of EDC was 76.5% in the population of haemodialysis patients in the wilaya of Laghouat, of whom 48.8% had mild depression, 27.7% had mild to moderate depression and 23.5% had moderate to severe depression. Five factors were found to be strongly correlated with the severity of depression, which was confirmed in multivariate analysis by ordinal logistic regression with: profession, average socioeconomic level, distance of haemodialysis centre from home, frequent dialysis incidents and accidents, duration of haemodialysis treatment. The risk of having severe depressive symptoms was 50.15 times for patients who had dialysis incidents during haemodialysis sessions,
25.99 times for non-active patients, 9.45 times for patients who had been on haemodialysis for between 1 and 2 years, 4.78 times for patients whose distance from home centre was greater than 100km, 3.75 times for patients whose socio-economic status was average.
Conclusion: This study shows that depression is common in chronic haemodialysis patients and is often unrecognised and underestimated. Early diagnosis and management of the haemodialysis patient must be multidisciplinary. Collaboration between psychiatrists and nephrologists must begin as early as possible in order to inform the patient of the difficulties that are likely to arise during the course of treatment. The aim is to reduce the severity of depression and improve quality of life by keeping patients active and improving their socio-economic conditions, by creating new centres close to haemodialysis patients' homes and by preventing frequent dialysis incidents and accidents.
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