Anxiety and Depression - A Suicidal Risk in Patients with Chronic Renal Failure on Maintenance Hemodialysis

Background: Depression and anxiety is well established as a prevalent mental health problem in end-stage renal disease patients treated with hemodialysis. However these problem remains difficult to assess and is undertreated. Aims & Objective: To assess the demographic and psychological factors associated with depression among hemodialysis patients and elucidated the relationships between depression, anxiety, fatigue, poor health-related quality of life, and increased suicide risk. Method: This cross-sectional study enrolled 150 end-stage renal disease patients age >18 years on hemodialysis. Psychological characteristics were assessed with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the short-form Health-Related Quality of Life Scale, and Chalder Fatigue Scale, and structural equation modeling was used to analyze the models and the strength of relationships between variables and suicidal ideation. Results: Of the 150 patients, 70 (46.6%) had depression symptoms, and 43 (28.6%) had suicidal ideation in the previous month. Depression was significantly correlated with a low body mass index (BMI) and the number of co morbid physical illnesses. Depressed patients had greater levels of fatigue and anxiety, more common suicidal ideation, and poorer quality of life than nondepressed patients. Results revealed a significant direct effect for depression and anxiety on suicidal ideation. Conclusion: Among hemodialysis patients, depression was associated with a low BMI and an increased number of comorbid physical illnesses. Depression and anxiety were robust indicators of suicidal ideation. A prospective study would prove helpful in determining whether early detection and early intervention of comorbid depression and anxiety among hemodialysis patients would reduce suicide risk. dependency on treatment may negatively affect quality of life and exacerbate feelings associated with a loss of control. 2,3 Postulated explanations for high incidence and prevalence of ESRD in India include high prevalence of diabetes and incidence of chronic kidney disease, failure to identify patients with an early stage of chronic kidney disease. Roughly 95% of ESRD patients in India are on hemodialysis. 5 Among ESRD patients undergoing hemodialysis, besides the disease itself; accompanying modifications in the occupational, marital, familial, social, and personal life provide a sufficient base to give rise to anxiety. The effects of illness, dietary constraints, time restrictions, financial burdens, feeling of handicap, psychological strain of awareness of impending death, and many such factors impede the normal life, therefore, it is important to determine the psychological effects of hemodialysis. The co morbidities of depression and anxiety increased over time in subjects who were on hemodialysis. 11 The incidence of anxiety a common disorder in hemodialysis patients, is 27%-46%.