Celiac Disease
Total Page:16
File Type:pdf, Size:1020Kb
Original Article DEPRESSION IN HEMODIALYSIS PATIENTS Muhammad Anees1, Haris Barki2, Mahrukh Masood3, Muhammad Ibrahim4, Asim Mumtaz5 ABSTRACT Objective: To measure the frequency of depression and its risk factors in patients under going hemodialysis. Methodology: It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1st January 2006 to 30th April 2006. All patients getting regular hemodialysis for more than three months were included. Beck’s Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Results: Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 ± 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. KEY WORDS: Renal failure, Depression, Hemodialysis, Illetracy. Pak J Med Sci July - September 2008 Vol. 24 No. 4 560-565 How to cite this article: Anees M, Barki H, Masood M, Mumtaz A, Kausar T. Depression in hemodialysis patients. Pak J Med Sci 2008;24(4):560-5. INTRODUCTION person will fail to show compliance and the medical illness exacerbates due to lack of Depression plays a crucial role in the preventive measures. Moreover, loss of appe- progression of chronic medical illnesses. People tite creates nutritional deficiencies to make the with depression feels so hopeless that they things even worse. Deterioration of physical abandon the will to survive. Consequently the health would deepen the depression to create Correspondence a vicious cycle. Chronic kidney disease is also a chronic medical illness. Independent of the Dr. Muhammad Anees, 726-L Block, Johar Town, cause of kidney disease physical fitness Lahore - Pakistan. decreases with its progression till the develop- E-mail: [email protected] ment of end stage renal disease (ESRD). * Received for Publication: April 5, 2008 Patients on hemodialysis may manifest * Accepted: July 9, 2008 various psychiatric problems like affective 560 Pak J Med Sci 2008 Vol. 24 No. 4 www.pjms.com.pk Depression in hemodialysis patients disorders, dementia and personality disorders.1 of each patient was drawn for hematological Amongst all psychiatric disorders depression (Hb) and biochemical parameters (urea, crea- is the most important and common in patients tinine, sodium, potassium, calcium, potassium, with ESRD. Depression in dialysis patients not phosphorus, albumin, ALT, HbsAg, Anti Hcv). only effect mortality2 but increased rate of hos- Statistical Analysis: Data was analyzed on SPSS pitalizations3 and dialysis withdrawal4 is also for windows (ver 12.00) and Student T test was very common. applied to test the correlation among different Depression is also related with quality of life variables. The multiple logistic regression model and increased cardiovascular morbidity.2,5 Sui- was used to determine the predictive strength cidal tendencies or attempt is significantly more of depression with nominal variables (sex, common among dialysis patients than general marital status, education, number of children, population.6 The incidence of depression in financial support). The overall model was dialysis patients ranges from 10% to 66%.7 This tested by using Chi Square statistic. wide variation is due to different criteria and methods used to diagnose depression.8 In RESULTS Pakistan, due to paucity of indigenous data the frequency of depression in dialysis patients is Mean age was 49 years. Majority of the not known, so this cross-sectional study was patients were male fifty two(58.4%) and sev- conducted to check the frequency of depres- enty seven(86.5%) were married. There was no sion and its risk factors in two major dialysis history of smoking and addiction in sixty nine centers of Lahore, Pakistan. (77.5%) and eighty seven (97.7%) patients respectively. Ninety percent of patients had METHODOLOGY education up to 10th grade. Major cause of end stage renal disease (ESRD) was diabetic neph- This study was conducted at hemodialysis ropathy in forty one (46.1%) and hypertensive units of Shalamar and Shaikh Zayed Hospital, nephropathy in twenty (22.5%) followed by Lahore, from 1st January 2006 to 30th April chronic glomerulonephritis, nephrolithiasis 2006. A self administered questionnaire- Beck and other causes. Family members were in the Depression Inventory (BDI- II) comprising of range of 01 to 30 with mean of seven members 21 items; adapted in Urdu was filled by all the in each family. Mean depression scale was patients as a screening diagnostic tool. The 19.64. Fifteen (27%) were mild, twenty three questionnaire was filled out only by those (25.8%) moderately and twenty seven (30.3%) patients who were able to read or understand were severely depressed. Majority of patients it. Patients with dementia, delirium and who had anemia, hypoalbuminemia and were unable to understand that questionnaire hyperphosphatemia. It was observed that the were excluded from the study. A proforma con- risk factors (marital status, education, number sisting of relevant demographic variables (sex, of children, financial support,) have significant education, marital status, number of children, association with depression as shown in family members, family system, any financial Table-I. support, history of smoking and addiction) was The value of model chi-square is 21.0563 also administered. A diagnostic criterion for (P- value = 0.04) with d.f = 12. This is highly depression was taken from Diagnostic and Sta- significant therefore; we are 95% confident that tistical Manual of Mental Disorders, (DSM IV). the fitted model is appropriate. Grading of depression was done according to severity levels: Nil (less than 9 depression scale), Logit Model for Overall Analysis: mild (depression scale 10-15), moderate (16 – Depression grade = 1.06 + 2.126 × Sex ÷ 0.790 24 depression scale) and severe (25 and × Marital Status – 1.752 × Education + 0.364 × above).9 At the same time pulse and blood pres- Number of children + 0.560 × Financial sure was checked and recorded. Blood sample support. Pak J Med Sci 2008 Vol. 24 No. 4 www.pjms.com.pk 561 Muhammad Anees et al. Table-I: Logistic regression output S.No Variable ß S.E(ß) d.f P-Value Odds Ratio 1 Sex 2.126 1.0402 1 0.069 0.8925 2 Marital Status 0.790 0.200 1 0.000* 2.204 3 Education -1.75 0.328 1 0.000* 0.2536 4 Number of children 0.364 0.294 1 0.015* 0.695 5 Financial Support 0.560 0.192 1 0.004* 0.2536 6 Constant 1.062 0.336 1 0.002* 2.892 * Statistically significant value DISCUSSION of depression like insomnia, fatigue, diminished interest which is also supported by other stud- Depression is generally accepted to be the ies in Pakistan.19 Majority of patients eighty one most common psychological problem in (91.1%) had education up to 10th grade. Due patients with ESRD.2 Depression is character- to lack of education and misperceptions about ized by both cognitive and somatic features. the disease, they reached the dialysis centers The somatic characteristic of depression is simi- in more miserable conditions. Socioeconomic lar to symptoms of uremia like anorexia, sleep factors play important role in depression. In disturbance, fatigue, gastrointestinal disorders 10 Pakistan average per capita income is 430US and pain. Due to this overlap of symptoms of dollars and 35% of the population falls below uremia with depression it is usually neglected, the poverty line. Dialysis costs about 250US under diagnosed and remain untreated. There dollars/month and most of the patients are is substantial variation in the percentage of either unemployed or not earning enough. In depression in dialysis patients (25%- 60%) in this study monthly income does not have sta- 12,13 different geographical areas. This wide tistically significant relationship with depres- variation is due to different criteria’s used for sion but patients who were getting any finan- depression and social factors affecting the pa- cial support from NGOs, hospital and/ or or- tients in different geographical regions. In this ganization were less depressed as compared study, the majority of patients sixty five (72%) to those who were not. Same thing was ob- were mild to severely depressed with mean served by Kojma et al.,20 Bokhari et al,17 has scale of depression of 19.64±11.75, according found that depression is positively associated to Beck Depression Inventory (BDI-II). This with income level below rupees five thousand ratio came out to be same as that of a study per month. In this study marital status and 11 conducted in Turkey. The frequency of number of children in a family had statistically depression in dialysis patients is 72%, which is significant (P- value <0.05) association with much higher as compared to the depression in depression in these patients. Being a married general population of Pakistan (06% to person the subjects are guardian of 5-7 depen- 14,15 6 30%), patients of cancer (17.8%), coronary dents, and sole bread winner of their family.