Anxiety In Dialysis Patients Research Articles

Emotional Reactivity and Death Anxiety in Dialysis Patients

Aim: This study was conducted as a correlational and comparative pilot study to determine the relationship between emotional reactivity and death anxiety in dialysis patients. Method: The study was conducted with a total of 140 people, including 70 hemodialysis (HD) and 70 peritoneal dialysis (PD) patients. A questionnaire form, Turkish Death Anxiety Scale (TDAS) and Emotion Reactivity Scale (ERS) were used for data collection. Results: There was no difference between the mean ERS and TDAS scores of hemodialysis and peritoneal dialysis patients. A moderate positive correlation was found between the mean ERS and TDAS scores in HD and PD groups (p<0.05). It was determined that 15.3% of TDAS scores of hemodialysis patients and 26.2% of TDAS scores of PD patients are explained by ERS. Conclusion: It was observed that death anxiety and emotional reactivity were at a moderate level in hemodialysis and peritoneal dialysis patients and there was a similarity between dialysis modalities.

How Do the ASCEND Study Findings Help Us as Dialysis Patients?

How Do the ASCEND Study Findings Help Us as Dialysis Patients?

اثربخشی درمان شناختی مبتنی بر ذهن آگاهی بر کاهش شدت درد و اضطراب مرگ در بیماران دیالیزی: یک مطالعه راهنما

Background and Objective: Patients with renal failure are more prone to depression than others and have higher death anxiety. The aim of this study was to determine the effectiveness of mindfulness-based cognitive therapy on reducing pain intensity and death anxiety among patients undergoing dialysis. Materials and Methods: This study was semi-experimental and in the form of a pretest-posttest design with a control group. The statistical population of this study consisted of all patients who were referred to dialysis ward of Al-Jalil hospital in Aqqala city in the first quarter of 2019, among whom 22 patients were selected by convenience sampling method and randomly assigned to experimental and control groups. First, a pre-test was held. The experimental group then received mindfulness-based cognitive therapy for eight sessions of 90 minutes, and the control group did not receive any training. Then the post-test was held. Data collection tools were pain intensity and death anxiety questionnaires. Data were analyzed using univariate covariance analysis, and the above statistical analysis was performed using SPSS.22 software. The significance level of the tests was 0.05. Results: In the experimental group, the mean (SD) of death anxiety decreased from 10.0 (1.5) in the pre-test to 6.3 (1.1) in the post-test (P<0.001). Also, in the experimental group, the mean (SD) pain intensity decreased from 31.7 (7.8) in the pre-test to 22.9 (6.5) in the post-test (P<0.001). There was no significant difference between the mean (SD) of death anxiety scores and pain intensity in the control group in pre-test and post-test. Conclusion: The study showed that mindfulness-based cognitive therapy reduced pain intensity and death anxiety in dialysis patients.

General distress and symptoms of anxiety and depression: A factor analysis in two cohorts of dialysis patients

ObjectiveDepression and anxiety often coexist in patients with end-stage-kidney disease. Recently, studies showed that a composite ‘general distress score’ which combines depression and anxiety symptoms provides a good fit in dialysis and oncology patients. We aim to investigate if the three most frequently used self-report questionnaires to measure depression and anxiety in dialysis patients are sufficiently unidimensional to warrant the use of such a general distress score in two cohorts of dialysis patients. MethodsThis study includes two prospective observational cohorts of dialysis patients (total n = 749) which measured depression and anxiety using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses was used to investigate both a strictly unidimensional model and a multidimensional bifactor model that includes a general distress, depression and anxiety factor. The comparative fit index (CFI) and The Root Mean Square Error of Approximation (RMSEA) were used as model fit indices. ResultsFactor analysis did not show a good fit for a strictly unidimensional general distress factor for both the BDI/BAI and HADS (CFI 0.690 and 0.699, RMSEA 0.079 and 0.125 respectively). The multidimensional model performed better with a moderate fit for the BDI/BAI and HADS (CFI 0.873 and 0.839, RMSEA 0.052 and 0.102). ConclusionsThis data shows that the BDI/BAI and HADS are insufficiently unidimensional to warrant the use of a general distress score in dialysis patients without also investigating anxiety and depression separately. Future research is needed whether the use of a general distress score might be beneficial to identify patients in need of additional (psychological) support.

Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients

ObjectiveSymptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. MethodsThis study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. ResultsIn total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45–2.06) p = .007 and Hazard Ratio 1.65 (1.15–2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. ConclusionThis study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.

Screening for anxiety and depression in dialysis patients: Comparison of the Hospital Anxiety and Depression Scale and the Beck Depression Inventory

ObjectiveAlthough anxiety and depression are frequent comorbid disorders in dialysis patients, they remain underrecognized and often untreated. The aim of the study was to evaluate the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI) and a truncated version of the BDI, the Cognitive Depression Index (CDI), as screening tools for anxiety and depression in dialysis patients. MethodsA total of 109 participants (69.7% males), from four dialysis centers, completed the self-report symptom scales HADS and BDI. Depression and anxiety disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). The sensitivity, specificity, positive and negative predictive value, overall agreement, kappa and receiver operating characteristic (ROC) curves were assessed. ResultsDepressive disorders were found in 22% of the patients based on the SCID-I, while anxiety disorders occurred in 17%. The optimal screening cut-off score for depression was ≥7 for the HADS depression subscale (HADS-D), ≥14 for the HADS-total, ≥11 for the CDI and ≥17 for the BDI. The optimal screening cut-off for anxiety was ≥6 for the HADS anxiety subscale (HADS-A) and ≥14 for the HADS-total. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8; BDI: 16), the BDI performed slightly better than HADS-D. ConclusionThe BDI, CDI and HADS demonstrated acceptable performance as screening tools for depression, as did the HADS-A for anxiety, in our sample of dialysis patients. The recommended cut-off scores for each instrument were: ≥17 for BDI, ≥11 for CDI, ≥7 for HADS depression subscale, ≥6 for HADS anxiety subscale and ≥14 for HADS total. The CDI did not perform better than the BDI in our study. Lower cut-off for the HADS-A than recommended in medically ill patients may be considered when screening for anxiety in dialysis patients.

The Influence of Psychological Intervention on Cognitive Appraisal and Level of Anxiety in Dialysis Patients: A Pilot Study

Objective: The great progress with the application of a dialysis allows patients with the end-stage renal disease to live in a satisfactory somatic state for many years. This pilot study examined if the psychological intervention improves psychic state of the patients with renal disease undergoing hemodyalisis. Methods: The study was a randomized controlled trial using a convenience sample of 62 fully informed and consenting patients with the end-stage renal disease who were assigned to experimental (psychological intervention) or control (usual care) groups. Participants in the experimental group listened to a CD with a psychological intervention twice a day during 3 weeks. The instruments were the Cognitive Appraisal Inventory and the STAI-Anxiety Inventory. Results: After the application of a psychological intervention, the experimental group had a lower level of anxiety t(30) = 2.99; p < .005, a weaker intensity of cognitive appraisal of the treatment situation as a threat t(30)=3.48; p < .05, a weaker intensity of cognitive appraisal of the situation as a harm/loss t(30)=2.75; p < .05 and a stronger intensity of cognitive appraisal of the situation as a challenge t(30) = 3.49; p < .05. The applied psychological intervention makes it possible to decrease the level of anxiety and to change cognitive appraisal of treatment situation. Conclusions: The applied psychological intervention influences the patients' psychological state in a positive way. Such changes may indirectly contribute to improving social contacts as well as to increasing satisfaction with the undertaken activities.