Depressive and Anxiety Symptoms in Dutch Immigrant and Native Dialysis Patients

  • Wim L. Loosman
  • Gertrud L. G. Haverkamp
  • Tessa O. van den Beukel
  • Tiny Hoekstra
  • Friedo W. Dekker
  • Prataap K. Chandie Shaw
  • Yves F. C. Smets
  • Louis-Jean Vleming
  • Pieter M. Ter Wee
  • Carl E. H. Siegert
  • Adriaan Honig
Original Paper


Due to continuing migration there is more interest in the mental health status of immigrants. The aim of this study is to determine the prevalence of depressive/anxiety symptoms in immigrant and native dialysis patients, and to explore if patient characteristics can explain differences. The Beck depression inventory and the beck anxiety inventory were used. Differences between native and immigrant patients were explored using logistic regression models adjusted for patient characteristics. The prevalence of depressive symptoms was 35% for 245 native patients and 50% for 249 immigrant patients. The prevalence of anxiety symptoms was 35% for native patients and 50% for immigrant patients. In addition, the prevalence for co-morbid depressive and anxiety symptoms was 20% for native patients and 32% for immigrant patients. Crude ORs for depressive/anxiety symptoms for immigrant patients versus native patients were 1.8 (1.2–2.5) and 1.7 (1.2–2.5), respectively. After adjustment for patient characteristics ORs remained the same. Clinicians should be aware that immigrant dialysis patients are more prone to develop depressive and anxiety symptoms. Cultural factors might play a role and should therefore be assessed in future research.


Anxiety Depression Dialysis Immigrant Ethnicity 



This study was funded by the Dutch Kidney Foundation (SB 174). The Kidney Foundation had no influence in study design whatsoever. We thank the nurses and participating dialysis centres of the DIVERS study for collection and management of the data. We gratefully thank all patients who participated in the DIVERS study.


This study was funded by the Dutch Kidney Foundation (Grant No. SB 174).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10903_2018_722_MOESM1_ESM.pdf (95 kb)
Supplementary material 1 (PDF 94 KB)


  1. 1.
    Palmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, Pellegrini F, Saglimbene V, Logroscino G, Fishbane S, Strippoli GF. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Farrokhi F, Abedi N, Beyene J, Kurdyak P, Jassal SV. Association between depression and mortality in patients receiving long-term dialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014;63(4):623–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Lacson E Jr, Bruce L, Li NC, Mooney A, Maddux FW. Depressive affect and hospitalization risk in incident hemodialysis patients. Clin J Am Soc Nephrol 2014;9(10):1713–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Garcia-Llana H, Remor E, Del PG, Selgas R. The role of depression, anxiety, stress and adherence to treatment in dialysis patients health-related quality of life: a systematic review of the literature. Nefrologia 2014;34(5):637–57.PubMedGoogle Scholar
  5. 5.
    Cruz LN, Fleck MP, Polanczyk CA. Depression as a determinant of quality of life in patients with chronic disease: data from Brazil. Soc Psychiatry Psychiatr Epidemiol. 2010;45(10):953–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Preljevic VT, Osthus TB, Os I, Sandvik L, Opjordsmoen S, Nordhus IH, Dammen T. Anxiety and depressive disorders in dialysis patients: association to health-related quality of life and mortality. Gen Hosp Psychiatry. 2013;35(6):619–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Kutner NG, Fair PL, Kutner MH. Assessing depression and anxiety in chronic dialysis patients. J Psychosom Res. 1985;29(1):23–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, Spielman LA, Peterson RA, Kimmel PL. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis. 2008;52(1):128–36.CrossRefPubMedGoogle Scholar
  9. 9.
    Bossola M, Ciciarelli C, Di SE, Conte GL, Vulpio C, Luciani G, Tazza L. Correlates of symptoms of depression and anxiety in chronic hemodialysis patients. Gen Hosp Psychiatry. 2010;32(2):125–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Zhang M, Kim JC, Li Y, Shapiro BB, Porszasz J, Bross R, Feroze U, Upreti R, Martin D, Kalantar-Zadeh K, Kopple JD. Relation between anxiety, depression, and physical activity and performance in maintenance hemodialysis patients. J Ren Nutr. 2014;24(4):252–60.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Feroze U, Martin D, Kalantar-Zadeh K, Kim JC, Reina-Patton A, Kopple JD. Anxiety and depression in maintenance dialysis patients: preliminary data of a cross-sectional study and brief literature review. J Ren Nutr. 2012;22(1):207–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Vaughn LM, Jacquez F, Lindquist-Grantz R, Parsons A, Melink K. Immigrants as research partners: a review of immigrants in community-based participatory research (CBPR). J Immigr Minor Health 2016;19(6):1457–68.CrossRefGoogle Scholar
  13. 13.
    de Wit MA, Tuinebreijer WC, Dekker J, Beekman AJ, Gorissen WH, Schrier AC, Penninx BW, Komproe IH, Verhoeff AP. Depressive and anxiety disorders in different ethnic groups: a population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam. Soc Psychiatry Psychiatr Epidemiol. 2008;43(11):905–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Missinne S, Bracke P. Depressive symptoms among immigrants and ethnic minorities: a population based study in 23 European countries. Soc Psychiatry Psychiatr Epidemiol. 2012;47(1):97–109.CrossRefPubMedGoogle Scholar
  15. 15.
    Haverkamp GL, Torensma B, Vergouwen AC, Honig A. Psychological distress in the hospital setting: a comparison between native dutch and immigrant patients. PLoS ONE. 2015;10(6):e0130961.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Tarricone I, Stivanello E, Poggi F, Castorini V, Marseglia MV, Fantini MP, Berardi D. Ethnic variation in the prevalence of depression and anxiety in primary care: a systematic review and meta-analysis. Psychiatry Res 2012;195(3):91–106.CrossRefPubMedGoogle Scholar
  17. 17.
    Goodkin DA, Bragg-Gresham JL, Koenig KG, Wolfe RA, Akiba T, Andreucci VE, Saito A, Rayner HC, Kurokawa K, Port FK, Held PJ, Young EW. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the dialysis outcomes and practice patterns study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270–7.CrossRefPubMedGoogle Scholar
  18. 18.
    van Dijk PC, Jager KJ, de CF, Collart, Cornet F, Dekker R, Gronhagen-Riska FW, Kramar C, Leivestad R, Simpson T, Briggs K. JD. Renal replacement therapy in Europe: the results of a collaborative effort by the ERA-EDTA registry and six national or regional registries. Nephrol Dial Transplant. 2001;16(6):1120–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Davies SJ, Russell L, Bryan J, Phillips L, Russell GI. Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. Am J Kidney Dis. 1995;26(2):353–61.CrossRefPubMedGoogle Scholar
  20. 20.
    Loosman WL, Hoekstra T, van Dijk S, Terwee CB, Honig A, Siegert CE, Dekker FW. Short-Form 12 or Short-Form 36 to measure quality-of-life changes in dialysis patients? Nephrol Dial Transplant 2015;30(7):1170–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Statistics Netherlands. Someone with a foreign background. Accessed 26 June 2014.
  22. 22.
    Stronks K, Kulu-Glasgow I, Agyemang C. The utility of ‘country of birth’ for the classification of ethnic groups in health research: the Dutch experience. Ethn Health. 2009;14(3):255–69.CrossRefPubMedGoogle Scholar
  23. 23.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–71.CrossRefGoogle Scholar
  24. 24.
    Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Loosman WL, Siegert CE, Korzec A. Validity of the hospital anxiety and depression scale and the beck depression inventory for use in end-stage renal disease patients. Br J Clin Psychol. 2010;49:507–16.CrossRefPubMedGoogle Scholar
  26. 26.
    Wang MY, Chan SF, Chang LI, Chen TH, Tsai PS. Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: a cross-sectional observational study. Int J Nurs Stud. 2013;50(11):1468–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Che HH, Lu ML, Chen HC, Chang SW, Lee YJ. Validation of the Chinese version of the beck anxiety inventory. Formos J Med 2006;10:447–54.Google Scholar
  28. 28.
    Wong EC, Miles JN. Prevalence and correlates of depression among new U.S. immigrants. J Immigr Minor Health. 2014;16(3):422–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Testa R, Bonfigli AR, Genovese S, Ceriello A. Focus on migrants with type 2 diabetes mellitus in European Countries. Intern Emerg Med. 2016;11(3):319–26.CrossRefPubMedGoogle Scholar
  30. 30.
    van den Beukel TO, Verduijn M, le Cessie S, Jager KJ, Boeschoten EW, Krediet RT, Siegert CE, Honig A, Dekker FW. The role of psychosocial factors in ethnic differences in survival on dialysis in the Netherlands. Nephrol Dial Transplant. 2012;27(6):2472–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Koneru VK, de Mamani AGW, Flynn PM, Betancourt H. Acculturation and mental health: current findings and recommendations for future research. Appl Prev Psychol. 2007;12:76–96.CrossRefGoogle Scholar
  32. 32.
    Haverkamp GL, Loosman WL, van den Beukel TO, Hoekstra T, Dekker FW, Chandie Shaw PK, Smets Y. The association of acculturation and depressive and anxiety symptoms in immigrant chronic dialysis patients. Gen Hosp Psychiatry 2015;38:26–30.CrossRefPubMedGoogle Scholar
  33. 33.
    Ramirez SP, Macedo DS, Sales PM, Figueiredo SM, Daher EF, Araujo SM, Pargament KI, Hyphantis TN, Carvalho AF. The relationship between religious coping, psychological distress and quality of life in hemodialysis patients. J Psychosom Res. 2012;72(2):129–35.CrossRefPubMedGoogle Scholar
  34. 34.
    Patel SS, Shah VS, Peterson RA, Kimmel PL. Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis. Am J Kidney Dis. 2002;40(5):1013–22.CrossRefPubMedGoogle Scholar
  35. 35.
    Fernandez A, Loukas A. Acculturation and religious coping as moderators of the association between discrimination and depressive symptoms among Mexican–American vocational students. J Immigr Minor Health. 2014;16(6):1290–3.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Wim L. Loosman
    • 1
    • 2
  • Gertrud L. G. Haverkamp
    • 1
    • 2
  • Tessa O. van den Beukel
    • 3
  • Tiny Hoekstra
    • 4
  • Friedo W. Dekker
    • 4
  • Prataap K. Chandie Shaw
    • 5
  • Yves F. C. Smets
    • 1
  • Louis-Jean Vleming
    • 6
  • Pieter M. Ter Wee
    • 7
  • Carl E. H. Siegert
    • 1
  • Adriaan Honig
    • 2
    • 8
  1. 1.Department of NephrologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  2. 2.Department of PsychiatryOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
  3. 3.Department of Internal MedicineVU University medical centerAmsterdamThe Netherlands
  4. 4.Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
  5. 5.Department of NephrologyMedical Center HaaglandenThe HagueThe Netherlands
  6. 6.Department of NephrologyHaga HospitalThe HagueThe Netherlands
  7. 7.Department of NephrologyVU University medical centerAmsterdamThe Netherlands
  8. 8.Department of PsychiatryVU University medical centerAmsterdamThe Netherlands

Personalised recommendations