ارتباط متقابل اضطراب و افسردگی با کیفیت زندگی در مرحله نهایی بیماری کلیه

Endstage renal disease (ESRD) is increasingly being recognized as a major public health issue globally. Planning of intervention measures is preferably hinged on what is known about outcome parameters. Objectives This study investigated the influence of anxiety with depression and psychosocial- and treatment-related correlates on quality of life (QOL) in ESRD. Methodology Overall, 100 eligible individuals with ESRD were recruited by systematic random sampling technique. They were initially interviewed using the sociodemographic/clinical profile questionnaire, followed by assessment with the Hospital Anxiety and Depression Scale. Subsequently, subjective QOL of participants was assessed using the World Health Organization QOL-BREF. Results The mean age of participants was 41.9 ± 10.9 years, and males (55.0%) were preponderant. A total of 29 (29.0%) participants had diagnosable anxiety with depression psychopathology based on Hospital Anxiety and Depression Scale scores ≥ 8. Different degrees of impairment across domains of QOL were observed. Factors like being employed, married status, younger age, and spending less on treatment correlated positively with good QOL across specific domains, whereas comorbid anxiety with depression, history of dialysis, monthly income less than ₦50,000 ($300), and having up to 50 dialysis sessions correlated negatively with good outcome in specific domains of QOL (p < 0.05). However, only age, anxiety/depression, employment, and history of dialysis were independently related to QOL following logistic regression analyses. Conclusion The care of ESRD should be matched with need-based mental health services, and psychosocial support across important illness trajectories is indicated for best outcome. Further research among people with ESRD is also warranted.

The number of individuals with endstage renal disease (ESRD) (defined by glomerular filtration rate <15 mL/min) is growing rapidly worldwide, and in particular across the developing countries. This is partly linked to better case identification, considerable improvement in the physical health, and longer life expectancy among individuals with ESRD owing to advancement in their care.1 and 2 The trend in common socioeconomic and health factors that are related to ESRD across most developing countries (shown for Nigeria in Table 1) is likely to compound the burden and management of ESRD. Table 1. Profile of Key Public Health and Social Factors in Nigeria Factors Value Population estimates of Nigerians (2013) Total 174,507,539 Urban 49.6% Life expectancy (2013), y Total 52.46 Male 49.35 Female 55.77 Burden of common health conditions, % Obesity in adults (2008) 6.5 Malnutrition 4 Hypertension 24.8 Diabetes 4.9 National Health Insurance coverage, % National coverage (2013) 8 Coverage varies across different states Five causes of deaths in Nigeria (2010), % Malaria 20 Lower respiratory infection 19 HIV/AIDS 9 Diarrhea diseases 5 Injuries 5 http://www.indexmundi.com/nigeria/demographics_profile.html. Accessed February 12, 2014. http://www.punchng.com/news/life-expectancy-in-nigeria-17th-lowest-globally-report/. Accessed February 12, 2014. http://www.thisdaylive.com/articles/universal-health-coverage-nigeria-lags-behind-target-by-22-/159587/. http://www.cdc.gov/globalhealth/countries/nigeria/why/default.htm. http://www.africanjournalofdiabetesmedicine.com/articles/november_2012/AJDM%20Nov%20pp%2033-35.pdf. Isezuo et al: 2011 Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria. Hum Hypertens 2011; 25(4):224–230. doi:10.1038/jhh.2010.56. Full-size table Table options View in workspace Download as CSV As obtainable in other chronic diseases, the focus of intervention in ESRD is preferably broadened beyond the traditional health indicators of reduction in mortality3 to include measures that are focused on its effects on daily activities, functional status, and perceived health measures like quality of life (QOL) among others.4 In this regard, QOL is an important measure of the global effect of diseases like ESRD on the affected individuals because it captures their relationship to the environment (which corresponds to “functional status” and “environmental living conditions” in its definition in modern times).5 and 6 In addition, QOL is recognized as a useful predictor of hospitalization as well as mortality in individuals with ESRD.7 A review of literature from the developed world suggests poorer QOL and higher emotional burden among individuals with ESRD in comparison with the general population.1 Despite the paucity of literature, there are a number of reasons to suggest that people with ESRD in the developing countries would suffer poor QOL and significant psychiatric morbidities. Such reasons include lack of government funding, poor health insurance coverage, and inequitable distribution of renal dialysis as well as transplantation services, among others. In places where these renal services are available, they are predominantly urban-based and generally inaccessible.8 and 9 Regarding psychiatric comorbidities, anxiety along with depression disorders seems very common among individuals with ESRD,10 and 11 and in particular, those on hemodialysis contributing up to 3-fold more hospitalizations in comparison with individuals with ESRD without psychiatric disorders.12 Beyond the foregoing, anxiety with depression in ESRD negatively affects the clinical course, morbidity, and outcome13 and 14 as well as constitutes independent associated factor of QOL in ESRD, based on existing literature.15 Generally, there seems to be relative improvement in ESRD care across Africa, albeit slow. However, development of holistic care for people with ESRD appears daunting across most African populations owing to dearth of information, poor infection control, poverty, delayed referral, and the fact that only approximately 5% of Africans with ESRD end up having renal transplant, among others.16, 17, 18, 19, 20 and 21 Overall, the dismal projection for ESRD burden coupled with the aforementioned factors underscores the role of population-based preventive interventions as well as research into the emotional experiences of individuals with ESRD.8 To this end, this study aims to investigate the profile of QOL and its relationship with anxiety, depression as well as other psychosocial correlates among individuals with ESRD.

Different degrees of impairment of QOL across multiple domains were observed among individuals with ESRD. Comorbid anxiety with depression and psychosocial- and treatment-related factors constitute determinants of poor QOL in the setting of ESRD. Routine screening for coexisting psychiatric disorders among people with ESRD is encouraged to facilitate early referral and intervention. Holistic care with inclusion of comprehensive mental health services and psychosocial and financial support is indicated to improve outcome in individuals with ESRD. For instance, the burden of care is enormous for individuals with ESRD, and there is need for aid from the government as well as relevant nongovernmental organizations toward relieving the implied financial load. Further research focusing on indicators of good outcome in ESRD and their determinants is warranted.