Saudi Journal of Kidney Diseases and Transplantation

BRIEF COMMUNICATION
Year
: 2018  |  Volume : 29  |  Issue : 5  |  Page : 1133--1138

Depression and impaired work productivity among hemodialysis patients in south region of Saudi Arabia


Mohammed Abdullah AlShahrani1, Ahmad Saeed Mohammad Alayed1, Abdullah Hassan AlShehri1, Osama Solaiman1, Nabil J Awadalla2, Mohammed Alhomrany1,  
1 Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia

Correspondence Address:
Prof. Mohammed Alhomrany
Department of Internal Medicine, King Khalid University, P. O. Box 641, Abha
Saudi Arabia

Abstract

Various studies have been published in different regions and countries about the prevalence of depression and its relationship with sociodemographic factors in patients on hemodialysis (HD). However, a gap in knowledge about the prevalence, correlates, detection, and treatment of depression and symptoms among dialysis patients in the Kingdom of Saudi Arabia. This is cross-sectional study to assess the prevalence of depression in HD patients and work productivity in Aseer region using Beck’s questionnaire to screen depression and work productivity and activity impairment questionnaire to assess the work productivity. The study was conducted in two governmental centers one in Abha and one in Khamis Mushait and involved 233 patients. Participants were interviewed personally and responded to specially designed structured anonymous questionnaire composed of four parts; sociodemographic, clinical and laboratory, Beck’s depression inventory, and impaired productivity scale. Of the HD patients studied, 42% and 48.4% were suffering from clinical depression and impaired work productivity, respectively. The risk of clinical depression was significantly higher in the age group >40 years old and when the duration of dialysis is >5 years. Prevalence of clinical depression and impaired work productivity are relatively high among HD patients in Abha and Khamis Mushait cities.



How to cite this article:
AlShahrani MA, Alayed AS, AlShehri AH, Solaiman O, Awadalla NJ, Alhomrany M. Depression and impaired work productivity among hemodialysis patients in south region of Saudi Arabia.Saudi J Kidney Dis Transpl 2018;29:1133-1138


How to cite this URL:
AlShahrani MA, Alayed AS, AlShehri AH, Solaiman O, Awadalla NJ, Alhomrany M. Depression and impaired work productivity among hemodialysis patients in south region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2019 Jun 17 ];29:1133-1138
Available from: http://www.sjkdt.org/text.asp?2018/29/5/1133/243970


Full Text

 Introduction



Depression is considered the leading cause of disability in the world (measured by years of life lived with disability) in 1990[1] and is expected to be the world’s second leading cause of disability, surpassed only by cardiovascular disease the Kingdom of Saudi Arabia (KSA) in 2020.[2]

Many comorbidities seen in hemodialysis (HD) patients have direct impact on patients quality of life.[3]

Mental health problems like depression is one of comorbidities in HD patients that are well established.[4] Various studies have been published about depression and its relationship to sociodemographic factors in patients on HD.[3],[5],[6],[7] However, a gap in knowledge about the prevalence, correlates, detection, and treatment of depression and symptoms among dialysis patients in KSA presents specially in southern regions.

The study aimed to study the prevalence of depression and work productivity on HD patients in Aseer region.

Based on cross-sectional method, we used Beck’s questionnaire to screen depression and work productivity and activity impairment questionnaire to assess the work productivity.

The study was conducted in two governmental centers one in Abha and one in Khamis Mushait to assess the prevalence and determinants of clinical depression and impaired work productivity among HD.

 Methods



A cross-sectional observational study was conducted from 2016 to 2017 on 233 HD patients recruited from all private and governmental HD centers in Abha and Khamis Mushait cities.

Participants were interviewed personally and responded to specially designed structured anonymous questionnaire composed of four parts; sociodemographic, clinical and laboratory, Beck’s depression inventory, and impaired productivity scale.

Medical data used in the study were duration on HD (in years) and frequency (per week) of dialysis.

The purpose and study protocols were explained to participants, after which participants gave verbal informed consent.

To be eligible for this study, participants had to be over 15 years of age who were diagnosed with end-stage renal disease (ESRD) and currently on HD treatment, clinically stable, ambulant, able to understand and answer the questionnaires and able to participate voluntarily.

A structured study questionnaire was developed which included sociodemographic characteristics, clinical profile related to renal failure and dialysis and medical history.

Procedure of data was collected crosssectionally. The patients were assessed in a single session and, the data were interviewer-based on both responses from the patient as well as family members.

All the tests were administered and scored by a trained clinical psychologist. All patients were interviewed face-to-face by the research team, all researchers received practical training on using Beck’s Depression Inventory-II (BDI-II) (Aron. T. Beck, 1996)[8] to maintain consistency in questionnaire administration.

The BDI-II is a 21-item self-report instrument for measuring the severity of depression in psychiatrically diagnosed adults and adolescent patients aged 13 years and older.

The psychometric characteristics of BDI-II indicate reliability with an internal consistency; the coefficient alphas are 0.92 and 0.93.

Test-retest stability was seen to be significant. Construct validity of BDI-II was performed in comparison with several other psychological tests used in clinics; BDI-II was noted to have good construct validity and factorial validity.[8]

 Results



Sociodemographic and clinical data are shown in [Table 1] and [Table 2]. The results show that 42% and 48.4% of HD patients were suffering from clinical depression and impaired work productivity, respectively. [Figure 1] shows the percentage of different grades of depression, 16% of patients had severe to extreme depression and in 10% of the study group, the depression was observed on clinical ground. [Table 3] shows the work capacity scores in 62 patients of the study samples. Average of 15 h is missed weekly because of the dialysis treatment in the employed patients. On scale of 10, an average of 4.7 estimated the effect of dialysis on their daily activities. The risk of clinical depression was significantly higher in the age group >40 years old [odds ratio (OR) = 2.99, 95% confidence interval (CI): 1.53–5.68] and duration of dialysis more than five years (OR = 3.03, 95% CI: 1.34–6.83). On the other hand, the following factors were found to be protective; non-Saudi nationality (OR = 0.292 %CI; 0.106–0.804), education higher than secon-dary school (OR = 0.46% CI: 0.24–0.85), marital status (OR = 0.52 % CI: 0.27–0.98), and higher income (OR = 1.023 %, CI: 0.606–1.728). While the risk of impaired work productivity was significantly higher in the age group >40 years old (OR = 3.30, 95% CI: 1.16–9.34) and in females (OR = 7.5, 95% CI: 1.48–37.9) and in those with comorbid conditions [Table 4].{Table 1}{Table 2}{Figure 1}{Table 3}{Table 4}

 Discussion



Depression is usually under diagnosed and not treated in dialysis patients, which may be due to the overlapping of somatic symptoms of depression and uremia (such as sleep disturbance, anorexia, fatigue, sexual dysfunction, and gastrointestinal upsets).[7]

Different methods have been used in the literature to assess depression in patients with ESRD leading to a great variability in results.[9]

In our study, we used the BDI-II questionnaire, which has been tested and validated in many studies.[7],[8],[9]

The study showed that 42% and 48.4% of HD patients were suffering from clinical depression and impaired work productivity, respectively.

Clinical depression in correlation with social demographic factors was found to be significantly higher with age more than 40 years old in whom 48% have a clinical depression. Furthermore, clinical depression was significantly observed in patients with a level of education lower than secondary school. Our study agrees with other studies which correlates depression with being single.[10],[11] This emphasize the need of social and spousal support for patients treated with HD.

Clinical depression in correlation with social impaired productivity was found to be significantly higher in age of >40 years old, 63.3% of these patients have clinical depression, female gender and being >40 years of age were shown to be more significantly associated with clinical depression.

 Conclusion



The prevalences of clinical depression and impaired work productivity are relatively high among HD patients in Abha and Khamis Mushait cities.

Attention should be paid to screening and managing depression among HD patients. Vocational rehabilitation should be planned for those patients to encourage work and productivity.

Conflict of interest: None declared.

References

1Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med 1998;4:1241-3.
2Ustün TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJ. Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004;184:386-92.
3Turkistani I, Nuqali A, Badawi M, et al. The prevalence of anxiety and depression among end-stage renal disease patients on hemodialysis in Saudi Arabia. Ren Fail 2014;36: 1510-5.
4Al-Homrany MA, Bilal AM. Psycho-social features of chronic dialysis patients in Saudi Arabia: Experience of one centre. Saudi J Kidney Dis Transpl 2001;12:164-71.
5Jondeby MS, De-Los Santos GG, Al-Ghamdi AM, et al. Caring for hemodialysis patients in Saudi Arabia. Past, present and future. Saudi Med J 2001;22:199-204.
6Theofilou P. Depression and anxiety in patients with chronic renal failure: The effect of sociodemographic characteristics. Int J Nephrol 2011;2011:514070.
7Griva K, Kang AW, Yu ZL, et al. Quality of life and emotional distress between patients on peritoneal dialysis versus community-based hemodialysis. Qual Life Res 2014;23:57-66.
8Kimmel PL. Depression in patients with chronic renal disease: What we know and what we need to know. J Psychosom Res 2002;53: 951-6.
9Beck AT, Steer RA. Becks Anxiety Inventory. San Antonio, USA: The Psychological Corporation, Harcourt Brace and Company; 1993.
10Molarius A, Berglund K, Eriksson C, et al. Mental health symptoms in relation to socioeconomic conditions and lifestyle factors – A population-based study in Sweden. BMC Public Health 2009;9:302.
11Scarinci IC, Beech BM, Naumann W, Kovach KW, Pugh L, Fapohunda B. Depression, socioeconomic status, age, and marital status in black women: A national study. Ethn Dis 2002;12:421-8.