Determination of Beck Depression Inventory Scores of the Patients in a Hemodialysis Center: Evaluation with a Holistic Approach

Öz

Aim/ Background: The holistic approach in medicine refers to addressing an individual as a whole. Family physicians should be familiar with psychological as well as physical problems of their hemodialysis patients. This study aims to measure depressive mood levels of patients in a hemodialysis center, and to investigate the potential risk factors with a holistic approach. Method: This study was conducted on patients receiving treatment at a private hemodialysis center. During the hemodialysis session, the patients’s blood samples were taken, and serum phosphorus, creatinine, albumin, and hematocrit levels were measured. A semi-structured questionnaire form was used to investigate the sociodemographic characteristics and the Beck Depression Inventory (BDI) was used to determine depressive mood level of the patients. Results: This study was conducted on a sample of 88 patients (33 female, 55 male). The mean BDI scores were 16.7±9.8, and when the cut-off point of BDl was taken as 15, the rate of depressive mood was %56.8 for hemodialysis patients. We evaluated the duration of illness, family structure, educational level, having non-renal comorbid disease, employment status, economic status, and also blood creatinine, albumin, phosphorus, and hematocrit levels. The mean BDI score was significantly lower in patients who lived in simple nuclear families with fewer than six individuals at home. Conclusion: The holistic approach is essential, especially in chronic disease follow-up in primary healthcare. Family support and psychological evaluation with a holistic approach are vital for hemodialysis patients.

Anahtar Kelimeler

• Chronic renal failure
• depression
• family physician
• hemodialysis
• holistic approach

Bir Hemodiyaliz Merkezindeki Hastalarının Beck Depresyon Envanteri Puanlarının Belirlenmesi: Holistik Bir Yaklaşımla Değerlendirme

Öz

Amaç: Tıpta bütüncül yaklaşım, bireyi bir bütün olarak ele almayı ifade eder. Aile hekimleri, takip ettikleri hemodiyaliz hastalarının fiziksel problemleri kadar psikolojik sorunlarından da haberdar olmalıdır. Bu çalışmada, bir hemodiyaliz merkezinde tedavi gören hastaların depresif duygudurum seviyesi ve olası risk faktörlerini bütüncül yaklaşımla tespit etmeyi amaçladık. Yöntem: Bu çalışma, özel bir hemodiyaliz merkezinde tedavi gören hastalar üzerinde gerçekleştirildi. Hemodiyaliz seansı sırasında hastalar tartılarak diyete uyum tespiti yapıldı, serum fosfor, kreatinin, albümin ve hematokrit düzeyleri ölçüldü. Hastaların sosyodemografik özelliklerini araştırmak için yarı yapılandırılmış bir anket formu ve depresif duygudurum seviyesinin belirlenmesi için Beck Depresyon Envanteri (BDE) kullanıldı. Bulgular: Bu çalışma 88 hastadan (33 kadın, 55 erkek) oluşan bir örnek üzerinde yürütülmüştür. Ortalama BDE skoru 16.7 ± 9.8 idi ve BDE'nin kesme noktası 15 olarak alındığında, hemodiyaliz hastalarında depresyon oranı % 56.8 idi. Hastalık süresi, aile yapısı, eğitim düzeyi, böbrek dışı komorbid hastalık varlığı, istihdam durumu, ekonomik durum ve ayrıca kan kreatinin, albümin, fosfor ve hematokrit düzeyleri değerlendirildi. Evde altı kişiden az birey olan basit çekirdek ailelerde yaşayan hastalarda ortalama BDE skoru anlamlı olarak düşük saptandı. Sonuç: Bütüncül yaklaşım birinci basamakta özellikle kronik hastalık takibinde önemlidir. Hemodiyaliz hastaları için aile desteği ve bütüncül bir yaklaşımla psikolojik değerlendirme hayatidir.

Anahtar Kelimeler

• Kronik böbrek yetmezliği
• depresyon
• aile hekimi
• hemodiyaliz
• bütüncül yaklaşım

Kaynakça

1. 1. Sanyaolu A, Okorie C, Annan R, Turkey H, Akhtar N, Gray F, et al. Epidemiology and management of chronic renal failure: a global public health problem. Biostatistics Epidemiol Int J. 2018;1(1):11-16.
2. 2. Paulman P, Taylor RB, Paulman AA, et al. (Eds) Family medicine: Principles and practice. Fam. Med. Princ. Pract. 2017.
3. 3. Saxena R, West C. Peritoneal Dialysis: A Primary Care Perspective. J Am Board Fam Med. 2006;19(4):380-9.
4. 4. Major RW, Shepherd D, Medcalf JF, Xu G, Gray LJ, Brunskill NJ. The Kidney Failure Risk Equation for prediction of end-stage renal disease in UK primary care: An external validation and clinical impact projection cohort study. PLoS Med. 2019;16(11):e1002955. doi:10.1371/journal.pmed.1002955
5. 5. McKercher CM, Venn AJ, Blizzard L, Nelson MR, Palmer AJ, Ashby MA, et al. Psychosocial factors in adults with chronic kidney disease: Characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC Nephrol. 2013;12;14:83.
6. 6. Mendes A. Psychology in kidney care: an inherent part of practice. Journal of Kidney Care.2017;2(3):180–181. doi:10.12968/jokc.2017.2.3.180
7. 7. Junior GBS, Barbosa AMO, Silva GPF, Lima GR, Santana CC, Silva TG, et al. Depressive symptoms in chronic kidney disease: A comparison between patients on dialysis versus conservative treatment. Nefrol. Latinoam. 2017;14(4):153-159.
8. 8. Spielberger CD. Manual for the State-Trait Anxiety Inventory (STAI Form Y). Consult. Psychol. Palo Alto. 1983.

9. 9. Cohen SD, Cukor D, Kimmel PL. Anxiety in patients treated with hemodialysis. Clin. J. Am. Soc. Nephrol. 2016;7;11(12):2250-2255.
10. 10. Guan Y, He YX. Effect of advanced care on psychological condition in patients with chronic renal failure undergoing hemodialysis: A protocol of a systematic review. Medicine (Baltimore).2019;98(10):e14738. doi:10.1097/MD.0000000000014738
11. 11. Maglakelidze N, Pantsulaia T, Tchokhonelidze I, Managadze L, Chkhotua A. Assessment of health-related quality of life in renal transplant recipients and dialysis patients. Transplant. Proc. 2011;43(1):376-9.
12. 12. Constitution W. World Health Organisation. Geneva (www who int/en). 1946.
13. 13. Kusnanto H, Agustian D, Hilmanto D. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. J Family Med Prim Care 2018;7:497-500
14. 14. Choi NG, Sullivan JE, DiNitto DM, Kunik ME. Associations between psychological distress and health-related behaviors among adults with chronic kidney disease. Preventive Medicine. 2019. doi:10.1016/j.ypmed.2019.06.007
15. 15. D'Onofrio G, Simeoni M, Rizza P, Caroleo M, Capria M, Mazzitello G, et al. Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren. Fail. 2017;39(1):45-53.
16. 16. Jeon HO, Kim J, Kim O. Factors affecting depressive symptoms in employed hemodialysis patients with chronic renal failure, Psychology, Health & Medicine. 2019. doi: 10.1080/13548506.2019.1702218
17. 17. Hisli N. Beck Depresyon Envanterinin Geçirliği Üzerine Bir Çalışma, Psikoloji Dergisi; 1988. 6;118-126.
18. 18. Von Glischinski M, von Brachel R, Hirschfeld G. How depressed is "depressed"? A systematic review and diagnostic meta-analysis of optimal cut points for the Beck Depression Inventory revised (BDI-II). Qual Life Res. 2019;28(5):1111-1118.
19. 19. Bougioukas KI, Haidich AB. Medical Biostatistics: Basic Concepts. In: Papademetriou V., Andreadis E., Geladari C. (eds) Management of Hypertension. Springer, Cham. 2019.
20. 20. Ma TKW, Li PKT. Depression in dialysis patients. Nephrology. 2016;21(8):639–646. doi:10.1111/nep.12742
21. 21. Finkelstein SH. Depression in chronic dialysis patients: Assessment and treatment. Nephrol. Dial. Transplant. 2000;15(12):1911-3.
22. 22. Kokoszka A, Leszczyńska K, Radzio R, Daniewska D, Łukasiewicz A, Orzechowski WM, et al. Prevalence of depressive and anxiety disorders in dialysis patients with chronic kidney disease. Archives of Psychiatry and Psychotherapy. 2016; 1: 8–13 doi: 10.12740/APP/61977
23. 23. Nikolaou S, Tsagaridou M, Lavranos G, Kleinaki Z. The prevalence of depression in patients with chronic renal failure and its correlation with clinical risk factors. Archives of Hellenic Medicine. 2017;34(4):476-482.
24. 24. Senanayake S, Gunawardena N, Palihawadana P, Suraweera C, Karunarathna R, Kumara P. Depression and psychological distress in patients with chronic renal failure: Prevalence and associated factors in a rural district in Sri Lanka. Journal of Psychosomatic Research. 2018;112:25–31. doi:10.1016/j.jpsychores.2018.06.009
25. 25. Coulibaly G, Goumbri PP, Lengani HYA, Millogo T, Zoma VP, Dabilgou A, et al. Anxiété et dépression au cours de l’insuffisance rénale chronique avant le stade terminal au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou (Burkina Faso). Néphrologie & Thérapeutique.2019;15(7):506-510 doi:10.1016/j.nephro.2019.07.329
26. 26. Chen SF, Wang IJ, Lang HC. Risk of major depression in patients with chronic renal failure on different treatment modalities: A matched-cohort and population-based study in Taiwan. Hemodialysis International. 2015;20(1):98–105. doi:10.1111/hdi.12334
27. 27. Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: a prospective follow-up study. BMC Public Health. 2019;19:531.
28. 28. Ravaghi H, Behzadifar M, Behzadifar M, Taheri Mirghaed M, Aryankhesal A, Salemi M, et al. Prevalence of Depression in Hemodialysis Patients in Iran; A Systematic Review and Meta-analysis. Iranian Journal of Kidney Diseases. 2017;11(2):90-98.
29. 29. Nolen-Hoeksema S, Hilt LM. Gender differences in depression. In Handbook of Depression. Eds. Gotlib ıh, Hammen cl. 386–404, Guilford Press, New York, NY, USA, 2nd edition, 2009.
30. 30. Cirillo L, Cutruzzulà R, Somma C, Gregori M, Cestone G, Pizzarelli C, et al. Depressive Symptoms in Dialysis: Prevalence and Relationship with Uremia-Related Biochemical Parameters. Blood Purification. 2018;286–291. doi:10.1159/000491014
31. 31. Teles F, Albuquerque ALA, Lins IKFG, Medrado PC, Costa AFP. Quality of life and depression in haemodialysis patients, Psychology, Health & Medicine. 2018;23(9):1069-1078. doi: 10.1080/13548506.2018.1469779
32. 32. Kaveh K, Kimmel PL. Compliance in hemodialysis patients: Multidimensional measures in search of a gold standard. Am. J. Kidney Dis. 2001;37(2):244-66.
33. 33. Najafi A, Keihani S, Bagheri N, Ghanbari Jolfaei A, Mazaheri Meybodi A. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis. Iran J Psychiatry Behav Sci. 2016;10(2):e4962. doi:10.17795/ijpbs-4962
34. 34. Natashia D, Yen M, Chen HM, Fetzer SJ. Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia. Journal of Nursing Scholarship. 2019. doi:10.1111/jnu.12464
35. 35. Kimmel PL, Peterson RA, Weihs KL, Shidler N, Simmens SJ, Alleyne S, et al. Dyadic relationship conflict, gender, and mortality in urban hemodialysis patients. J. Am. Soc. Nephrol. 2000;11(8):1518-25.
36. 36. Baker DP, Leon J, Smith Greenaway EG, Collins J, Movit M. The education effect on population health: a reassessment. Popul Dev Rev. 2011;37(2):307–32.
37. 37. Freeman A, Tyrovolas S, Koyanagi A, Chatterji S, Leonardi M, Ayuso-Mateos JL, et al. The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe). BMC Public Health. 2016;16:1098. doi:10.1186/s12889-016-3638-0
38. 38. van Deurzen I, van Ingen E, van Oorschot WJH. Income Inequality and Depression: The Role of Social Comparisons and Coping Resources. European Sociological Review. 2015;31(4):477–489. doi:10.1093/esr/jcv007
39. 39. Ali BS, Rahbar MH, Naeem S, Tareen AL, Gul A, Samad L. Prevalence of and factors associated with anxiety and depression among women in a lower middle class semi-urban community of Karachi, Pakistan. J Pak Med Assoc. 2002;52(11):513–17.
40. 40. de Araújo AA, Barbosa RASR, de Menezes MSS, de Medeiros IIF, de Araújo Jr RF, de Medeiros CACX. Quality of Life, Family Support, and Comorbidities in Institutionalized Elders With and Without Symptoms of Depression. Psychiatr Q. 2016;87:281–291. doi:10.1007/s11126-015-9386-y