Abstract
Hemodialysis (HD) is demanding and debilitating. Often, patients undergo various changes; mentally and physically. Caregivers play a vital role in the management of patients. Yet, their psychological needs are usually overlooked or unmet by the medical team. This study examined whether anxiety and depressive symptoms in patients receiving HD treatment and their family caregivers predicted their quality of life (QOL) using the Actor-Partner Interdependence Model. A descriptive cross-sectional study in which dyads' (N = 128) depression, anxiety, and QOL were assessed using the General Anxiety Disorder-7, the Patient Health Questionnaire, and the World Health Organization Quality of Life Questionnaire, respectively. Both patients and caregivers had moderate levels of anxiety whereas patients had higher depression scores than caregivers. In all domains of QOL, caregivers had higher scores than patients; the highest score was for the Social Relationships domain (Mean = 63.81). The scores of both patients and caregivers on anxiety and depression demonstrated significant actor effects on all domains of QOL (p values < .001 for both members of the dyad). The caregiver’s anxiety and depression scores showed a significant partner effect only on the patient's Social Relationships domain of QOL. Thus, addressing the symptoms of depression and anxiety among patients and caregivers is highly important in managing patients receiving HD treatment.
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Data Availability
The authors of the study possess the data that support the findings. Interested individuals can request access to the data from the authors, subject to reasonable conditions and with the permission of the Hashemite University, Zarqa, Jordan.
References
Adejumo, O. A., Iyawe, I. O., Akinbodewa, A. A., Abolarin, O. S., & Alli, E. O. (2019). Burden, psychological well-being and quality of life of caregivers of end-stage renal disease patients. Ghana Medical Journal, 53(3), 190. https://doi.org/10.4314/gmj.v53i3.2
Alnazly, E. K. (2015). Burden and coping strategies among Jordanian caregivers of patients undergoing hemodialysis. Hemodialysis International, 20(1), 84–93. Portico. https://doi.org/10.1111/hdi.12318
Alradaydeh, M. F., & Khalil, A. A. (2018). The association of spiritual well-being and depression among patients receiving hemodialysis. Perspectives in Psychiatric Care, 54(3), 341–347. https://doi.org/10.1111/ppc.12249
Al-Rawashdeh, S. Y., Lennie, T. A., & Chung, M. L. (2017). The Association of Sleep Disturbances with Quality of Life in Heart Failure Patient-Caregiver Dyads. Western Journal of Nursing Research, 39(4), 492–506. https://doi.org/10.1177/0193945916672647
Al Sayah et al., 2013: Al Sayah, F., Ishaque, S., Lau, D., & Johnson, J. A. (2013). Health related quality of life measures in Arabic speaking populations: a systematic review on cross-cultural adaptation and measurement properties. Quality of Life Research, 22(1), 213-229. https://doi.org/10.1007/s11136-012-0129-3
Alshraifeen, A., Alnuaimi, K., Al-Rawashdeh, S., Ashour, A., Al-Ghabeesh, S., & Al-Smadi, A. (2020). Spirituality, anxiety, and depression among people receiving hemodialysis treatment in Jordan: A cross-sectional study. Journal of Religion and Health, 59(5), 2414–2429. https://doi.org/10.1007/s10943-020-00988-8
Attum, B., Hafiz, S., Malik, A., & Shamoon, Z. (2018). Cultural competence in the care of Muslim patients and their families.
Avsar, U., Avsar, U. Z., Cansever, Z., Yucel, A., Cankaya, E., Certez, H., & Yucelf, N. (2015). Caregiver burden, anxiety, depression, and sleep quality differences in caregivers of hemodialysis patients compared with renal transplant patients. Transplantation Proceedings, 47, 1388–1391. https://doi.org/10.1016/j.transproceed.2015.04.054
Brown, P. J., & Roose, S. P. (2011). Age and anxiety and depressive symptoms: The effect on domains of quality of life. International Journal of Geriatric Psychiatry, 26(12), 1260–1266. https://doi.org/10.1002/gps.2675
Chung, M. L., Moser, D. K., Lennie, T. A., & Rayens, M. K. (2009). The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using Actor-Partner Interdependence Model. Journal of Psychosomatic Research, 67(1), 29–35. https://doi.org/10.1016/j.jpsychores.2009.01.009
Einollahi, B., Taheri, S., Nemati, E., Abbaszadeh, S., Pourfarziani, V., & Nourbala, M. H. (2009). Burden among caregivers of kidney transplant recipients and its associated factors. Saudi Journal of Kidney Diseases and Transplantation, 20(1), 30.
Fan, L., Sarnak, M., Tighiouart, H., Drew, D., Kantor, A., Lou, K., Shaffi, K., Scott, T., & Weiner, D. (2014). Depression and all-cause mortality in haemodialysis patients. American Journal of Nephrology, 40, 12–18.
Firoz, M. N., Shafipour, V., Jafari, H., Hosseini, S. H., & Charati, J. Y. (2015). Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients. Global Journal of Health Science, 8(8), 121. https://doi.org/10.5539/gjhs.v8n8p121
Ganu, V. J., Boima, V., Adjei, D. N., Yendork, J. S., Dey, I. D., Yorke, E., et al. (2018). Depression and quality of life in patients on long term hemodialysis at a national hospital in Ghana: A cross-sectional study. Ghana Medical Journal, 52(1), 22–28. https://doi.org/10.4314/gmj.v52i1.5
Gerogianni, G., Polikandrioti, M., Babatsikou, F., Zyga, S., Alikari, V., Vasilopoulos, G., & Grapsa, E. (2019). Anxiety–depression of dialysis patients and their caregivers. Medicina, 55(5), 168. https://doi.org/10.3390/medicina55050168
Griva, K., Goh, C. S., Kang, W. C. A., Yu, Z. L., Chan, M. C., Wu, S. Y., & Foo, M. (2016). Quality of life and emotional distress in patients and burden in caregivers: a comparison between assisted peritoneal dialysis and self-care peritoneal dialysis. Quality of Life Research, 25(2), 373–384. https://doi.org/10.1007/s11136-015-1074-8
Hmwe, N. T. T., Subramanian, P., Tan, L. P., & Chong, W. K. (2015). The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: A randomized controlled trial. International Journal of Nursing Studies, 52(2), 509–518. https://doi.org/10.1016/j.ijnurstu.2014.11.002
Jadhav, B. S., Dhavale, H. S., Dere, S. S., & Dadarwala, D. D. (2014). Psychiatric morbidity, quality of life and caregiver burden in patients undergoing hemodialysis. Medical Journal of Dr. D.Y. Patil University, 7(6), 722. https://doi.org/10.4103/0975-2870.144858
Jordanian Ministry of Health (MOH). (2015). National registry of end stage renal disease. Retrieved February 4, 2019, from http://www.moh.gov.jo/Echobusv3.0/SystemAssets/25708778-d442-49b5 932df10c96601c2a.pdf.
Jahromi, M. K., Javadpour, S., Taheri, L., & Poorgholami, F. (2016). Effect of Nurse-Led Telephone Follow ups (Tele-Nursing) on Depression, Anxiety and Stress in Hemodialysis Patients. Global Journal of Health Science, 8(3), 168. https://doi.org/10.5539/gjhs.v8n3p168
Kelley, H., & Thibaut, J. (1978). Interpersonal relations: A theory of interdependence. Wiley-Interscience.
Kenny, D. A., Kashy, D., & Cook, W. L. (2006). Dyadic data analysis. Guilford Press.
Khalil, A. A., & Abed, M. A. (2014). Perceived Social Support is a Partial Mediator of the Relationship Between Depressive Symptoms and Quality of Life in Patients Receiving Hemodialysis. Archives of Psychiatric Nursing, 28(2), 114–118. https://doi.org/10.1016/j.apnu.2013.11.007
Khalil, A., Khalifeh, A. H., Al-Rawashdeh, S., Darawad, M., & Abed, M. (2022). Depressive Symptoms, Anxiety, and Quality of Life in Hemodialysis Patients and Their Caregivers: A Dyadic Analysis. Japanese Psychological Research, 64(4), 426–436. https://doi.org/10.1111/jpr.12339
Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements, 12(1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Ma, Y., Xiang, Q., Yan, C., Liao, H., & Wang, J. (2021). Relationship between chronic diseases and depression: The mediating effect of pain. BMC Psychiatry, 21(1), 1–11. https://doi.org/10.1186/s12888-021-03428-3
Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. General Hospital Psychiatry, 28(1), 71–77. https://doi.org/10.1016/j.genhosppsych.2005.07.003
McCarthy, M. J., Lyons, K. S., & Powers, L. E. (2011). Expanding poststroke depression research: Movement toward a dyadic perspective. Topics in Stroke Rehabilitation, 18, 450–460. https://doi.org/10.1310/tsr1805-450
Moore, C., Skevington, S., Wearden, A., & Mitra, S. (2020). Impact of dialysis on the dyadic relationship between male patients and their female partners. Qualitative Health Research, 30(3), 380–390. https://doi.org/10.1177/1049732319869908
Neumann, D., Lamprecht, J., Robinski, M., Mau, W., & Girndt, M. (2018). Social relationships and their impact on health-related outcomes in peritoneal versus hemodialysis patients: A prospective cohort study. Nephrology Dialysis Transplantation, 33(7), 1235–1244. https://doi.org/10.1093/ndt/gfx361
Parveen, S., Morrison, V., & Robinson, C. A. (2011). Ethnic variations in the caregiver role: A qualitative study. Journal of Health Psychology, 16(6), 862–872. https://doi.org/10.1177/1359105310392416
Pereira, B. D. S., Fernandes, N. D. S., de Melo, N. P., Abrita, R., Grincenkov, F. R. D. S., & Fernandes, N. M. D. S. (2017). Beyond quality of life: A cross sectional study on the mental health of patients with chronic kidney disease undergoing dialysis and their caregivers. Health and Quality of Life Outcomes, 15(1), 1–10. https://doi.org/10.1186/s12955-017-0646-4
Perrin, K. O., & MacLeod, C. E. (2018). Understanding the essentials of critical care nursing (3ed ed.). Pearson Prentice Hall.
Rayens, M. K., & Svavarsdottir, E. K. (2003). A new methodological approach in nursing research: An actor, partner, and interaction effect model for family outcomes. Research in Nursing & Health, 26, 409–419. https://doi.org/10.1002/nur.10100
Rebollo Rubio, A., Morales Asencio, J. M., & Raventos, E. P. M. (2017). Depression, anxiety and health-related quality of life amongst patients who are starting dialysis treatment. Journal of Renal Care, 43(2), 73–82. https://doi.org/10.1111/jorc.12195
Saeed, Z., Ahmad, A. M., Shakoor, A., Ghafoor, F., & Kanwal, S. (2012). Depression in patients on hemodialysis and their caregivers. Saudi Journal of Kidney Diseases and Transplantation, 23(5), 946.
Schouten, R. W., Harmse, V. J., Dekker, F. W., van Ballegooijen, W., Siegert, C. E., & Honig, A. (2019). Dimensions of depressive symptoms and their association with mortality, hospitalization, and quality of life in dialysis patients: A cohort study. Psychosomatic Medicine, 81(7), 649. https://doi.org/10.1097/psy.0000000000000723
Song, J. Y., & Oh, P. J. (2016). A study on symptom experience, spiritual well-being, and depression in patients undergoing hemodialysis. Journal of the Korea Academia-Industrial Cooperation Society, 17(5), 660–670.
Spitzer, R. L., Kroenke, K., Williams, J. B., Patient Health Questionnaire Primary Care Study Group. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. JAMA, 282(18), 1737–1744. https://doi.org/10.1001/jama.282.18.1737
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A Brief Measure for Assessing Generalized Anxiety Disorder. Archives of Internal Medicine, 166(10), 1092. https://doi.org/10.1001/archinte.166.10.1092
Tong, A., Sainsbury, P., & Craig, J. C. (2008). Support interventions for caregivers of people with chronic kidney disease: A systematic review. Nephrology Dialysis Transplantation, 23(12), 3960–3965. https://doi.org/10.1093/ndt/gfn415
Turan, O., Yemez, B., & Itil, O. (2014). The effects of anxiety and depression symptoms on treatment adherence in COPD patients. Primary Health Care Research & Development, 15(3), 244–251. https://doi.org/10.1017/s1463423613000169
Van Lange, P. A. M., & Balliet, D. (2015). Interdependence theory. In M. Mikulincer, P. R. Shaver, J. A. Simpson, & J. F. Dovidio (Eds.), APA handbook of personality and social psychology, Vol. 3. Interpersonal relations (pp. 65–92). American Psychological Association. https://doi.org/10.1037/14344-003
van Dijk, S., van den Beukel, T. O., Kaptein, A. A., Honig, A., le Cessie, S., Siegert, C. E., Boeschoten, E. W., Krediet, R. T., & Dekker, F. W. (2013). How baseline, new-onset, and persistent depressive symptoms are associated with cardiovascular and non-cardiovascular mortality in incident patients on chronic dialysis. Journal of Psychosomatic Research, 74(6), 511–517. https://doi.org/10.1016/j.jpsychores.2013.03.001
WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667
World Health Organization. (1996). WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996 (No. WHOQOL-BREF). Geneva: World Health Organization. Available online: https://www.who.int/mental_health/media/en/76.pdf. (Accessed on 4/11/2018).
Acknowledgements
The authors would like to thank all the participants who willingly shared their personal experiences and knowledge for the benefit of other HD patients and their caregivers. The authors would also like to thank the administrators, managers, and the dialysis nursing staff for their support and help in recruiting participants.
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“The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.”
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“All authors contributed to the study conception and design. Material preparation and data collection were performed by [Dr. Ali Alshraifeen] and [Dr. Karimeh Alnuaimi]. Data analysis and interpretation were performed by [Dr. Sami Al-Rawashdeh] and [Dr. Ali Alshraifeen]. The first draft of the manuscript was written by [Dr. Ali Alshraifeen], [Professor Loai Tawalbeh], and [Dr. Ala Ashour] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.”
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“This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ministry of Health (29162/984), (2) Jordan University of Science and Technology/Institutional Review Board (2016/99/7), and the Royal Medical Services Review Board (13945/1/3).
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“Informed consent was obtained from all individual participants included in the study.”
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Plain English Summary
Patients receiving hemodialysis (HD) complain of various psychological problems involving anxiety and depression. Recurrent hospitalizations, pain, and sleep impairment increase the risk of depression and anxiety. These psychological problems are also common among caregivers of patients on HD. Yet, the effect of such psychological problems on quality of life has not been sufficiently explained for dyads of patients receiving HD and their family caregivers’.
In this study, we examined whether anxiety and depression influence the QOL in HD patient-family caregiver dyads. The study indicates that both groups had anxiety and depression. Overall, patients’ psychological status negatively influenced their caregivers and vice versa. Findings from this study inspire more research about the psychological status of patients and caregivers and raise awareness towards adopting a wholistic care approach for both parties.
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Alshraifeen, A., Al-Rawashdeh, S., Alnuaimi, K. et al. Depression and anxiety predicted quality of life in dyads of people receiving hemodialysis treatment and their family caregivers. Curr Psychol 43, 8839–8851 (2024). https://doi.org/10.1007/s12144-023-04942-1
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DOI: https://doi.org/10.1007/s12144-023-04942-1