Document Details
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Document Type |
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Thesis |
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Document Title |
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IMPACT OF ANXIETY AND DEPRESSION ON QUALITY OF LIFE AMONG HEMODIALYSIS PATIENTS تاثيرالقلق والاكتئاب علي جودة الحياة يبن مرضي الغسيل الكلوي |
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Subject |
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Faculty of Nursing |
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Document Language |
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Arabic |
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Abstract |
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End-Stage Kidney Disease (ESKD) have become worldwide public health problems that increase patient morbidity risks and place a significant economic strain on a healthcare system. The number of patients on hemodialysis therapy in Saudi Arabia is continuously increasing. Depression and anxiety symptoms are linked to adverse clinical outcomes and may affect the quality of patients' life. The information about the quality of life, anxiety, and depression among hemodialysis patients in KSA is limited.
Study aim:
To assess the impact of anxiety and depression on quality of life among hemodialysis patients.
Materials and methods:
Study design
A quantitative, descriptive cross-sectional design was used in this study.
Setting
The study was carried out in the Diaverum Dialysis Centers, in Al-Qunfudhah province.
Sampling:
A convenience sample was selected. It consisted of 114 adults diagnosed with CKD receiving hemodialysis.
Instrument of the study:
The tool contains three parts. First, was demographic and clinical data. Second, Kidney Disease and Quality of Life survey (KDQOL™-36), and third, was the Hospital Anxiety and Depression Scale (HADS).
Ethical approval:
Written permission to conduct this study was obtained from the Faculty of Nursing at King Abdul-Aziz University and Diaverum Kidney Centers ethical committees.
Validity:
The tool contents were reviewed by seven experts in the medical-surgical field of the Faculty of Nursing at the University of King Abdul Aziz to test content validity, and item clarity. Experts’ comments and suggestion were considered and the tool was modified according to those remarks.
Reliability:
• In the present study, Cronbach's Alpha for the Arabic version of the KDQoL-36 questionnaire was 0.71, indicating a moderate internal consistency.
• For HADS tool, Cronbach's Alpha of the Arabic version was 0.85, indicating a very good internal consistency
• A pilot was conducted on 10% (15 patients). The pilot data were not included in the main study data.
Data collection process:
After the ethical approval was obtained, data collection was begun and continued for a period from July to September 2019. The researcher coordinated with the head of the Diaverum Kidney Centers to determine a strategy to inform HD patients about the study and identify eligible participants. The researcher explained the study aim to patients and obtained written consent from the participants, and the study instruments were then provided to the participants. The questionnaires took minutes approximately 15-30 for completion. Some participants were illiterate, so the researcher assisted them in completing the questionnaires.
Statistical analysis
Data were coded, organized, entered into the SPSS, and checked against the printed data to reduce any potential data entry errors. All data analyses were conducted using the Statistical Package for Social Sciences, version 21 (SPSS, Chicago, IL, USA). Continuous data are presented using mean and Standard deviation (SD) or median, and categorical variables are presented as counts and proportions (%). For comparison between anxiety and depression level among KDQOL domains, we used Mann U Whitney test. Correlation test was performed using Pearson's correlation coefficient. A comparison between different groups was tested using independent t-test and one-way ANOVA. A p-value of <0.05 (two-sided) was used to show statistical significance, and a p-value <0.01 was determined as highly statistically significant.
The main result of the study:
• Regarding socio-demographic and clinical characteristics: a high proportion of participants were women (64%), and more than half were illiterate (59.6%). More than half of the participants were married (53.5%), and most patients were living with their families (88.6%). The most common cause of renal failure was vascular or hypertension (50%), followed by diabetic nephropathy (20.2%). More than one-third of patients (38.6%) had 1 – 4 years of duration of dialysis.
• The overall score of KDQOL was 49.1 ± SD 18.7, which ranged from 9 to 91. Among the five QOL domains, the lowest scores were found in burden of disease and physical function (mean score 42.5±25.4 and 44.5± 25.9, respectively).
• Half of the participants were classified as having anxiety and 44.7% were identified as having depression symptoms. A positive, strong correlation was detected between anxiety and depression (r=0.745, p <0.001), suggesting anxiety positively affected depression.
• The results also showed that the higher total QOL score is significantly associated with anxiety and depression. Also, the Burden of Disease and Physical Component scores are associated with poor QOL of life and they are mostly affected with both anxiety and depression (p<0.001).
• There was a negative and moderate correlation found between anxiety, depression, and each domain of QOL (p<0.001).
• Older age group (≥65 years), female, divorced or widowed group, and illiterate patients are more associated with poor QOL along with anxiety and depression. Occupational status and monthly income levels were not statistically significant at KDQOL, anxiety, and depression.
Conclusion:
Considering the growing global prevalence of ESKD and increasing the importance of addressing mental health in CKD, improving information about psychological disturbances and its predictors on quality of life is important. On the basis of the findings, it is evident that the quality of life among hemodialysis patients is deemed low, while anxiety and depression are found to be highly prevalent among them.
Quality of life was negatively associated with anxiety and depression, whereas anxiety positively associated with depression. Among QOL domains, there is a negative correlation found between anxiety, depression, and each domain of QOL, the Burden of Disease and Physical Component scores are associated with poor QOL, and they are mostly affected with both anxiety and depression when compared to other domains. Furthermore, the present study revealed that the elderly, female, illiterate, and divorced or widowed participants were associated with poor QOL along with anxiety and depression. Thus, there is a need to develop new strategies to accurately focus on "high risk" patients who might gain a benefit from a preventive measure before complications begin.
Recommendations
• Healthcare providers, especially nurses who perform dialysis, should assess all patients for anxiety and depression regularly because the study has revealed a significant number of patients are affected by these symptoms.
• It is necessary to improve the diagnostic process and screening measures to detect anxiety and depression symptoms efficiently.
• Health education programs required for dialysis patients and cognitive behavioral therapy (CBT) intervention are both essential in the provision of improvements in quality of life, anxiety and depression.
• Future research is needed for a large probability sample and extended duration of follow-up for more generalization of the result. Also, further research is required in Saudi culture for investigating the anxiety and depression prevalence and its impacts on quality of life in dialysis and pre-dialysis stages. |
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Supervisor |
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Dr. Elham Al Nagshabandi |
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Thesis Type |
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Master Thesis |
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Publishing Year |
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1441 AH
2020 AD |
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Co-Supervisor |
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Dr. Hayfa Almutary |
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Added Date |
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Tuesday, June 30, 2020 |
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Researchers
| فاطمة ابراهيم الناشري | Al-Nashri, Fatimah Ibrahim | Researcher | Master | |
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