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Indicators and correlates of psychological disturbance in Chinese patients receiving maintenance hemodialysis: a cross-sectional study

  • Nephrology - Original Paper
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Abstract

Purpose

Depression and anxiety have been considered as the most common comorbidities in maintenance hemodialysis (MHD) patients. This study aimed to assess mental disorder in hemodialysis patients and to study the indicators and correlates of psychological disturbance among patients receiving MHD in China.

Methods

A cross-sectional study was conducted in 187 outpatients undergoing regular hemodialysis for at least 3 months. All the participants completed the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue, Chinese mainland version), Pittsburgh Sleep Quality Index (PSQI), Family APGAR Index (PAGAR), Family Adaptability and Cohesion Evaluation Scale (FACES II, Chinese version) and the Social Functioning Questionnaire (SFQ).

Results

Based on the cutoff point of HADS-D/A ≥8, 51 (27.3 %) and 29 (15.5 %) patients reported depression and anxiety, respectively; 26 (13.9 %) of all reported both depression and anxiety. Depressive patients had lower economic status, less subsidies, less than 3 years duration on hemodialysis and comorbidities when compared to patients without depression (all P < 0.05). HADS-D showed positive correlations with HADS-A, PSQI and SFQ and negative correlations with FACIT-Fatigue, PAGAR, family cohesion and adaptability (all P < 0.001). Patients with better family cohesion showed higher level of psychosocial well-being no matter their economic status. Binary logistic regression analysis demonstrated that anxiety (OR 1.80, P < 0.001) and bad social functioning (OR 1.31, P < 0.001) were independently associated with depression.

Conclusion

More attention should be paid on assessment and management psychological disturbance, and development family/social/medical supporting system for Chinese patients receiving MHD.

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References

  1. Vettath RE, Reddy YN, Reddy YN, Dutta S, Singh Z, Mathew M, Abraham G (2012) A multicenter cross-sectional study of mental and physical health depression in MHD patients. Indian J Nephrol 22(4):251–256

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Fidan F, Alkan BM, Tosun A, Altunoğlu A, Ardıçoğlu O (2013) Quality of life and correlation with musculoskeletal problems, hand disability and depression in patients with hemodialysis. Int J Rheum Dis. doi:10.1111/1756-185X.12171

    PubMed  Google Scholar 

  3. Edmondson D, Gamboa C, Cohen A, Anderson AH, Kutner N, Kronish I, Mills MA, Muntner P (2013) Association of posttraumatic stress disorder and depression with all-cause and cardiovascular disease mortality and hospitalization among Hurricane Katrina survivors with end-stage renal disease. Am J Public Health 103(4):e130–e137

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lacson E Jr, Li NC, Guerra-Dean S, Lazarus M, Hakim R, Finkelstein FO (2012) Depressive symptoms associate with high mortality risk and dialysis withdrawal in incident hemodialysis patients. Nephrol Dial Transplant 27(7):2921–2928

    Article  PubMed  Google Scholar 

  5. Denhaerynck K, Manhaeve D, Dobbels F, Garzoni D, Nolte C, De Geest S (2007) Prevalence and consequences of non adherence to hemodialysis regimens. Am J Crit Care 16(3):222–235

    PubMed  Google Scholar 

  6. Harris TJ, Nazir R, Khetpal P, Peterson RA, Chava P, Patel SS, Kimmel PL (2012) Pain, sleep disturbance and survival in hemodialysis patients. Nephrol Dial Transplant 27(2):758–765

    Article  PubMed Central  PubMed  Google Scholar 

  7. Macdonald JH, Fearn L, Jibani M, Marcora SM (2012) Exertional fatigue in patients with CKD. Am J Kidney Dis 60(6):930–939

    Article  PubMed  Google Scholar 

  8. Oyekçin DG, Gülpek D, Sahin EM, Mete L (2012) Depression, anxiety, body image, sexual functioning, and dyadic adjustment associated with dialysis type in chronic renal failure. Int J Psychiatry Med 43(3):227–241

    Article  PubMed  Google Scholar 

  9. Travers K, Martin A, Khankhel Z, Boye KS, Lee LJ (2013) Burden and management of chronic kidney disease in Japan: systematic review of the literature. Int J Nephrol Renovasc Dis 6:1–13

    Article  PubMed Central  PubMed  Google Scholar 

  10. Abdel-Kader K, Unruh ML, Weisbord SD (2009) Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 4(6):1057–1064

    Article  PubMed Central  PubMed  Google Scholar 

  11. Cukor D, Peterson RA, Cohen SD, Kimmel PL (2006) Depression in end-stage renal disease hemodialysis patients. Nat Clin Pract Nephrol 2(12):678–687

    Article  PubMed  Google Scholar 

  12. Cukor D, Coplan J, Brown C, Peterson RA, Kimmel PL (2008) Course of depression and anxiety diagnosis in patients treated with hemodialysis: a 16-month follow-up. Clin J Am Soc Nephrol 3(6):1752–1758

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hemati Z, Alidosti M, Sharifirad G, Kargar M (2013) The relationship between depression and quality of life among hemodialysis patients in Chaharmahal and Bakhtiari province in the year 2011. J Educ Health Promot 2:6

    Article  PubMed Central  PubMed  Google Scholar 

  14. Smith MD, Hong BA, Robson AM (1985) Diagnosis of depression in patients with end-stage renal disease. Comparative analysis. Am J Med 79(2):160–166

    Article  CAS  PubMed  Google Scholar 

  15. Rosenthal Asher D, Ver Halen N, Cukor D (2012) Depression and nonadherence predict mortality in hemodialysis treated end-stage renal disease patients. Hemodial Int 16(3):387–393

    Article  PubMed  Google Scholar 

  16. Rai M, Rustagi T, Rustagi S, Kohli R (2011) Depression, insomnia and sleep apnea in patients on maintenance hemodialysis. Indian J Nephrol 21(4):223–229

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Tezel A, Karabulutlu E, Sahin O (2011) Depression and perceived social support from family in Turkish patients with chronic renal failure treated by hemodialysis. J Res Med Sci 16(5):666–673

    PubMed Central  PubMed  Google Scholar 

  18. Khaira A, Mahajan S, Khatri P, Bhowmik D, Gupta S, Agarwal SK (2012) Depression and marital dissatisfaction among Indian hemodialysis patients and their spouses: a cross-sectional study. Ren Fail 34(3):316–322

    Article  PubMed  Google Scholar 

  19. Feroze U, Martin D, Kalantar-Zadeh K, Kim JC, Reina-Patton A, Kopple JD (2012) Anxiety and depression in maintenance dialysis patients: preliminary data of a cross-sectional study and brief literature review. J Ren Nutr 22(1):207–210

    Article  PubMed  Google Scholar 

  20. Chen CK, Tsai YC, Hsu HJ, Wu IW, Sun CY, Chou CC, Lee CC, Tsai CR, Wu MS, Wang LJ (2010) Depression and suicide risk in hemodialysis patients with chronic renal failure. Psychosomatics 51(6):528–528.e6

    Article  PubMed  Google Scholar 

  21. Bayat A, Kazemi R, Toghiani A, Mohebi B, Tabatabaee MN, Adibi N (2012) Psychological evaluation in hemodialysis patients. J Pak Med Assoc 62(3 Suppl 2):S1–S5

    PubMed  Google Scholar 

  22. Feroze U, Martin D, Reina-Patton A, Kalantar-Zadeh K, Kopple JD (2010) Mental health, depression, and anxiety in patients on maintenance dialysis. Iran J Kidney Dis 4(3):173–180

    PubMed  Google Scholar 

  23. Johnson S, Dwyer A (2008) Patient perceived barriers to treatment of depression and anxiety in hemodialysis patients. Clin Nephrol 69(3):201–206

    Article  CAS  PubMed  Google Scholar 

  24. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand Acta 67(6):361–370

    Article  CAS  Google Scholar 

  25. Olssøn I, Mykletun A, Dahl AA (2005) The hospital anxiety and depression rating scale: a cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 5:46

    Article  PubMed Central  PubMed  Google Scholar 

  26. Lee YJ, Kim MS, Cho S, Kim SR (2013) Association of depression and anxiety with reduced quality of life in patients with predialysis chronic kidney disease. Int J Clin Pract 67(4):363–368

    Article  PubMed  Google Scholar 

  27. Yu ZL, Yeoh LY, Seow YY, Luo XC, Griva K (2012) Evaluation of adherence and depression among patients on peritoneal dialysis. Singapore Med J 53(7):474–480

    PubMed  Google Scholar 

  28. Marie J, Beth P, Peter H (2000) Construct validation of hospital anxiety and depression scale with clinical populations. J Psychosom Res 48(6):579–584

    Article  Google Scholar 

  29. Mykletun A, Stordal E, Dahl AA (2001) Hospital anxiety and depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry 179:540–544

    Article  CAS  PubMed  Google Scholar 

  30. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the functional assessment of cancer therapy (FACT) measurement system. J Pain Symptom Manage 13(2):63–74

    Article  CAS  PubMed  Google Scholar 

  31. Hagell P, Höglund A, Reimer J, Eriksson B, Knutsson I, Widner H, Cella D (2006) Measuring fatigue in Parkinson’s disease: a psychometric study of two brief generic fatigue questionnaires. J Pain Symptom Manage 32(5):420–432

    Article  PubMed  Google Scholar 

  32. Chandran V, Bhella S, Schentag C, Gladman DD (2007) Functional Assessment of Chronic Illness Therapy-Fatigue Scale is valid in patients with psoriatic arthritis. Ann Rheum Dis 66(7):936–939

    Article  PubMed Central  PubMed  Google Scholar 

  33. Lai JS, Beaumont JL, Ogale S, Brunetta P, Cella D (2011) Validation of the Functional Assessment of Chronic Illness Therapy-Fatigue Scale in patients with moderately to severely active systemic lupus erythematosus, participating in a clinical trial. J Rheumatol 38(4):672–679

    Article  PubMed  Google Scholar 

  34. Wang SY, Zang XY, Liu JD, Gao M, Cheng M, Zhao Y (2014) Psychometric properties of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) in Chinese patients receiving maintenance dialysis. J Pain Symptom Manage. doi:10.1016/j.jpainsymman.2014.04.011

    Google Scholar 

  35. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  PubMed  Google Scholar 

  36. Liu XC, Tang MQ, Hu L, Wang AZ, Wu HX, Zhao GF, Gao CX, Li WS (1996) Reliability and validity of the Pittsburgh sleep quality index. Chin J Psychiatry 29(2):103–107

    Google Scholar 

  37. Smilkstein G (1978) The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract 6(6):1231–1239

    CAS  PubMed  Google Scholar 

  38. Olson DH (2000) Empirical approaches to family assessment. J Fam Ther 22:121–127

    Article  Google Scholar 

  39. Kurokawa J (1990) An attempt to standardize three scales (Japanese versions) which are based on the “Olson Circumplex Model”-family satisfaction, parent-adolescent communication and FACES III. J Fam Psychol 4:71–82

    Google Scholar 

  40. Engstroem I (1991) Family interaction and locus of control in children and adolescents with inflammatory bowel disease. J Am Acad Child Adolesc Psychiatry 30(6):913–920

    Article  Google Scholar 

  41. Fei LP, Shen QJ, Zheng YP, Zhao JP, Jiang SA, Wang LW, Wang XD (1991) Preliminary evaluation of Chinese version of FACES II and FES: comparison of normal families and families of schizophrenic patients. Chin Ment Health J 5(5):198–203

    Google Scholar 

  42. Tyrer P (1990) Personality disorder and social functioning. In: Peck DF, Shapiro CM (eds) Measuring human problems: a practical guide. John Wiley & Sons, Chichester, pp 119–142

    Google Scholar 

  43. Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, Spielman LA, Peterson RA, Kimmel PL (2008) Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis 52(1):128–136

    Article  PubMed  Google Scholar 

  44. Kimmel PL, Weihs KL, Peterson RA (1993) Survival in hemodialysis patients: the role of depression. J Am Soc Nephrol 4(1):12–27

    CAS  PubMed  Google Scholar 

  45. Peng T, Hu Z, Guo L, Xia Q, Li D, Yang X (2013) Relationship between psychiatric disorders and quality of life in nondialysis patients with chronic kidney disease. Am J Med Sci 345(3):218–221

    Article  PubMed  Google Scholar 

  46. Weissman MM, Bland RC, Canino GJ et al (1996) Cross-national epidemiology of major depression and bipolar disorder. JAMA 276(4):293–299

    Article  CAS  PubMed  Google Scholar 

  47. Frew AK, Drummond PD (2007) Negative affect, pain and sex: the role of endogenous opioids. Pain 132(Suppl 1):S77–S85

    Article  CAS  PubMed  Google Scholar 

  48. Stasiak CE, Bazan KS, Kuss RS, Schuinski AF, Baroni G (2014) Prevalence of anxiety and depression and its comorbidities in patients with chronic kidney disease on hemodialysis and peritoneal dialysis. J Bras Nefrol 36(3):325–331

    Article  PubMed  Google Scholar 

  49. Santos PR (2011) Depression and quality of life of hemodialysis patients living in a poor region of Brazil. Rev Bras Psiquiatr 33(4):332–337

    PubMed  Google Scholar 

  50. Abbas Tavallaii S, Ebrahimnia M, Shamspour N, Assari S (2009) Effect of depression on health care utilization in patients with end-stage renal disease treated with hemodialysis. Eur J Intern Med 20(4):411–414

    Article  PubMed  Google Scholar 

  51. Macaron G, Fahed M, Matar D, Bou-Khaloil R, Kazour F, Nehme-Chlela D, Richa S (2014) Anxiety, depression and suicidal ideation in Lebanese patients undergoing hemodialysis. Community Ment Health J 50(2):235–238

    Article  PubMed  Google Scholar 

  52. Kimmel PL (2000) Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: correlates and outcomes. Am J Kidney Dis 35(4 Suppl 1):S132–S140

    Article  CAS  PubMed  Google Scholar 

  53. Angst J, Gamma A, Gastpar M et al (2002) Gender differences in depression. Eur Arch Psychiatry Clin Neurosci 252(5):201–209

    Article  CAS  PubMed  Google Scholar 

  54. Giltay EJ, Tishova YA, Mskhalaya GJ, Gooren LJ, Saad F, Kalinchenko SY (2010) Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. J Sex Med 7(7):2572–2582

    CAS  PubMed  Google Scholar 

  55. Afsar B (2013) Relationship between total testosterone, cognitive function, depressive behavior, and sleep quality in chronic kidney disease patients not on dialysis. Clin Exp Nephrol 7(1):59–65

    Article  Google Scholar 

  56. Tell GS, Mittelmark MB, Hylander B, Shumaker SA, Russell G, Burkart JM (1995) Social support and health related quality of life in black and white dialysis patients. ANNA J 22(3):301–308

    CAS  PubMed  Google Scholar 

  57. Levy NB (2000) Psychiatric considerations in the primary medical care of the patient with renal failure. Adv Ren Replace Ther 7(3):231–238

    Article  CAS  PubMed  Google Scholar 

  58. Tyrer JP, Nur U, Crawford M, Karlsen S, MacLean C, Rao B, Johnson T (2005) The Social Functioning Questionnaire: a rapid and robust measure of perceived functioning. Int J Soc Psychiatry 51(3):265–275

    Article  PubMed  Google Scholar 

  59. Cano A, Scaturo DJ, Sprafkin RP, Lantinga LJ, Fiese BH, Brand F (2003) Family support, self-rated health, and psychological distress. Prim Care Companion J Clin Psychiatry 5(3):111–117

    Article  PubMed Central  PubMed  Google Scholar 

  60. Olson DH (1993) Circumplex model of marital and family systems. In: Walsh FW (ed) Normal families process. Guildford Press, New York, pp 58–80

    Google Scholar 

  61. Cao X, Jiang X, Li X, Hui Lo MC, Li R (2013) Family functioning and its predictors among disaster bereaved individuals in China: 18 months after Wenchuan earthquake. PLoS One 8(4):e60738

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Zimmer Z, Kwong J (2003) Family size and support of older adults in urban and rural China: current effects and future implications. Demography 40(1):23–44

    Article  PubMed  Google Scholar 

  63. Shen Y, Yeatts DE (2013) Social support and life satisfaction among older adults in China: family-based support versus community-based support. Int J Aging Hum Dev 77(3):189–209

    Article  PubMed  Google Scholar 

  64. Wang D, Zheng J, Kurosawa M, Inaba Y, Kato N (2009) Changes in activities of daily living (ADL) among elderly Chinese by marital status, living arrangement, and availability of healthcare over a 3-year period. Environ Health Prev Med 14(2):128–141

    Article  PubMed Central  PubMed  Google Scholar 

  65. Turner-Musa J, Leidner D, Simmens S, Reiss D, Kimmel PL, Holder B (1999) Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation. Soc Sci Med 48(10):1333–1340

    Article  CAS  PubMed  Google Scholar 

  66. Jhamb M, Weisbord SD, Steel JL, Unruh M (2008) Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factor. Am J Kidney Dis 52(2):353–365

    Article  PubMed Central  PubMed  Google Scholar 

  67. Bossola M, Vulpio C, Tazza L (2011) Fatigue in chronic dialysis patients. Semin Dial 24(5):550–555

    Article  PubMed  Google Scholar 

  68. Baglioni C, Spiegelhalder K, Lombardo C, Riemann D (2010) Sleep and emotions: a focus on insomnia. Sleep Med Rev 14(4):227–238

    Article  PubMed  Google Scholar 

  69. Macaron G, Fahed M, Matar D, Bou-Khalil R, Kazour F, Nehme-Chlela D, Richa S (2014) Anxiety, depression and suicidal ideation in lebanese patients undergoing hemodialysis. Community Ment Health J 50(2):235–238

    Article  PubMed  Google Scholar 

  70. Wang PL, Watnick SG (2004) Depression: a common but under recognized condition associated with end-stage renal disease. Semin Dial 17(3):237–241

    Article  CAS  PubMed  Google Scholar 

  71. Finkelstein FO, Watnick S, Finkelstein SH, Wuerth D (2002) The treatment of depression in patients maintained on dialysis. J Psychosom Res 53:957–960

    Article  PubMed  Google Scholar 

  72. Hedayati SS, Yalamanchili V, Finkelstein FO (2012) A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int 81(3):247–255

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This study was funded by Tianjin Medical University Graduated Research. The authors would like to express appreciation to the healthcare providers and patients of the Organ Transplant Center of Tianjin First Center Hospital for their support in data collection. They thank Mr. Jinbing Bai and Ms. Hong Zheng for editing this article.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. School of Nursing, Tianjin Medical University, 22 Qi Xiang Tai Road, Heping District, Tianjin, 300070, China

    Si-Yuan Wang, Xiao-Ying Zang, Mei Cheng, Yue-Xian Shi & Yue Zhao

  2. Organ Transplant Center, Tianjin First Center Hospital, Tianjin, China

    Jun-Duo Liu

  3. School of Nursing, Binzhou Medical University, Binzhou, China

    Mei Cheng

  4. Department of Nursing, Medical College Affiliated Hospital of Chinese People’s Armed Police Force, Tianjin, China

    Yue-Xian Shi

Authors
  1. Si-Yuan Wang
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  2. Xiao-Ying Zang
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  3. Jun-Duo Liu
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  4. Mei Cheng
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  5. Yue-Xian Shi
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  6. Yue Zhao
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Corresponding author

Correspondence to Yue Zhao.

Appendix: Hospital Anxiety and Depression Scale (HADS)

Appendix: Hospital Anxiety and Depression Scale (HADS)

  1. (A)

    I feel tense or “wound up”:

    • Most of the time-3

    • A lot of the time-2

    • From time to time, occasionally-1

    • Not at all-0

  2. (D)

    I still enjoy the things I used to enjoy:

    • Definitely as much-0

    • Not quite so much-1

    • Only a little-2

    • Hardly at all-3

  3. (A)

    I get a sort of frightened feeling as if something awful is about to happen:

    • Very definitely and quite badly-3

    • Yes, but not too badly-2

    • A little, but it doesn’t worry me-1

    • Not at all-0

  4. (D)

    I can laugh and see the funny side of things:

    • As much as I always could-0

    • Not quite so much now-1

    • Definitely not so much now-2

    • Not at all-3

  5. (A)

    Worrying thoughts go through my mind:

    • A great deal of the time-3

    • A lot of the time-2

    • From time to time, but not too often-1

    • Only occasionally-0

  6. (D)

    I feel cheerful:

    • Not at all-3

    • Not often-2

    • Sometimes-1

    • Most of the time-0

  7. (A)

    I can sit at ease and feel relaxed:

    • Definitely-0

    • Usually-1

    • Not Often-2

    • Not at all-3

  8. (A)

    I feel as if I am slowed down:

    • Nearly all the time-3

    • Very often-2

    • Sometimes-1

    • Not at all-0

  9. (A)

    I get a sort of frightened feeling like “butterflies” in the stomach:

    • Not at all-0

    • Occasionally-1

    • Quite Often-2

    • Very Often-3

  10. (D)

    I have lost interest in my appearance:

    • Definitely-3

    • I don’t take as much care as I should-2

    • I may not take quite as much care-1

    • I take just as much care as ever-0

  11. (A)

    I feel restless as I have to be on the move:

    • Very much indeed-3

    • Quite a lot-2

    • Not very much-1

    • Not at all-0

  12. (D)

    I look forward with enjoyment to things:

    • As much as I ever did-0

    • Rather less than I used to-1

    • Definitely less than I used to-2

    • Hardly at all-3

  13. (A)

    I get sudden feelings of panic:

    • Very often indeed-3

    • Quite often-2

    • Not very often-1

    • Not at all-0

  14. (D)

    I can enjoy a good book or radio or TV program:

    • Often-0

    • Sometimes-1

    • Not often-2

    • Very seldom-3

    • Scoring (add the As Anxiety. add the Ds Depression). The norms below will give you an idea of the level of Anxiety and Depression.

    • 0–7 = Normal

    • 8–10 = Borderline abnormal

    • 11–21 = Abnormal

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Wang, SY., Zang, XY., Liu, JD. et al. Indicators and correlates of psychological disturbance in Chinese patients receiving maintenance hemodialysis: a cross-sectional study. Int Urol Nephrol 47, 679–689 (2015). https://doi.org/10.1007/s11255-015-0910-7

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