Depressive symptom severity, contributing factors, and self‐management among chronic dialysis patients

Abstract

Background Despite the high prevalence of depressive symptoms in patients receiving chronic dialysis, there has been inadequate attention to patient-related barriers to management of depressive symptoms, such as factors identified by these patients as contributing to their symptoms, and how they responded to the symptoms. Methods Participants (N=210) in an ongoing longitudinal observational study of multidimensional quality of life in patients receiving chronic dialysis completed a battery of measures monthly for 12 months. For each patient at each measurement point an Event Report was generated if he/she scored outside of the normal range on the depressive symptom scale (CESD-SF ≥ 10) or expressed suicidal ideation. Results Of the 210 participants, 100 (47.6%) had a CESD-SF score ≥ 10 at least once resulting in 290 Event Reports. Of these 100 participants, 15 (15%) had also reported suicidal ideation in addition to having depressive symptoms. The most frequently stated contributing factors included ‘managing comorbid conditions and complications’ (56 Event Reports, 19.3%), ‘being on dialysis’ (50, 17.2%), ‘family or other personal issues’ (37, 12.8%), and ‘financial difficulties’ (31, 10.7%). On 11 Event Reports (3.8%) participants had been unaware of their depressive symptoms. On 119 Event Reports (41%) participants reported that they discussed these symptoms with their dialysis care providers or primary care providers, while on 171 Event Reports (59%) symptoms were not discussed with their healthcare providers. Conclusions The prevalence of depressive symptoms is high and many patients lack knowledge about effective self-management strategies.

Perceptions of resilience in patients undergoing peritoneal dialysis: A Q‐methodology study

“…In addition, factor 1 participants seemed to need social support, which refers to all positive resources generated by information and material assistance or interaction with others. These phenomena support the argument that social support is an important factor in the psychological and social adaptation of patients undergoing dialysis (Lee, Kim, & Lee, 2019;Wang et al, 2013) and is related to their compliance and survival (Song et al, 2016). Furthermore, this result suggests that efforts to improve social support ultimately contribute to enhancing resilience, which is supported by the following findings.…”

“…PD is a type of dialysis therapy; it is predominantly a self-care treatment performed by patients, their families, or caregivers. It involves the insertion of a peritoneal catheter into the abdomen with exchanges of fluid performed manually two to four times daily or overnight with an automated machine (Song, Ward, Hladik, Bridgman, & Gilet, 2016;Tong et al, 2013).…”

“…Patients undergoing dialysis experience negative emotional reactions, such as the physical pain caused by kidney dysfunction, stress from strict dietary control, intensified family conflicts due to changes in roles and responsibilities in the family caused by the loss of employment, and limited social activities. They are also more likely to experience fear of complications, frustration, helplessness, depression, and other problems (Song et al, ; Wang et al, ). Most patients with CKD experience serious changes in resilience when they consider their lack of ability to fulfill their life goals, because of the conflicts between independence and dependence that result from having an irreversible disease (Cho & Lee, ; Larsen & Lubkin, ).…”

Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management

“…The increased burden of self-care related to CKD and ESRD, including frequent clinic and hospital visits, dietary restrictions, increased pill burden, and home monitoring of glucose, blood pressure, and weight, may lead to depression. 48 , 56 This is added to the challenges associated with dialysis, such as traveling to the dialysis clinic 3 times weekly for hemodialysis, or performing daily home hemodialysis or peritoneal dialysis. These challenges can be particularly overwhelming for adults for whom dialysis has recently been initiated.…”

“… 51 , 52 In a study of 210 dialysis patients, of whom 100 had at least 1 prior episode of elevated depressive symptoms, 12.8% reported family or other personal issues, and 10.7% reported financial difficulties as contributing factors to depression. 56 …”