The Prevalence and Severity of Anxiety and Depression in Patients Undergoing Haemodialysis at Kenyatta National Hospital and M.p.shah Hospital in Nairobi, Kenya

Abstract

INTRODUCTION Patients on haemodialysis suffering from Chronic Kidney disease (CKD)/End Stage Renal Disease (ESRD) has been on the rise and the percentage increase is only second to that of HIV and AIDs. Common psychological disorders that patients on haemodialysis present with are Anxiety and Depression. These mood disorders impact dialysis patients’ quality of life negatively. AIM The primary goal of this research was to determine the prevalence and severity of anxiety and depression amongst patients undergoing maintenance haemodialysis (HD) at Kenyatta National Hospital and M.P. Shah Hospital in Nairobi, Kenya. The other aim was to assess the effect of various sociodemographic factors on the severity of anxiety and depression. METHOD This study is a cross-sectional descriptive study conducted at the dialysis departments of KNH and M.P. Shah hospital after appropriate approvals were sought and received. The study population was any adult undergoing maintenance HD who gave written consent and met the inclusion and exclusion criteria. The data collection tools used for this study were the sociodemographic questionnaire as well as the GAD 7 and PHQ 9 administered to assess anxiety and depression respectively. DATA ANALYSIS Data collected was analysed using Stata version 16. Bivariable analysis comparing sociodemographic categorical variables and depression as well as anxiety outcome was conducted using chi-square test. Student’s T-test was used to compare means for continuous variables between participants with depression and those without depression as well as those with anxiety and those without anxiety. Statistical significance was assessed using a p value < 0.05. Data was then tabulated and presented in graphs where appropriate. RESULTS A total of 160 patients participated in this study with a mean age of 50.1 (SD ± 16.9) years. The overall prevalence of depression was 72.5% (116 out of 160), with a prevalence of 82% (96 out of 117) in KNH and 47%(20 out of 43) in MP Shah. The mean PHQ 9 score was 9.3 (SD±6.4). Patients’ level of education (p= 0.003), history of alcohol use (p=0.022) and the hospital a patient attended (p<0.001) were significantly associated with depression. The prevalence of anxiety was 45% (72 out of 160), and 52% (61 out of 117) in KNH compared to MP Shah (p=0.003). There was a significant association between anxiety and gender (p=0.042). Anxiety was also significantly associated with level of formal education (p=0.025). CONCLUSION A high proportionate of patients on haemodialysis were diagnosed with anxiety and depression. Majority of the patients diagnosed with anxiety had mild anxiety, and those diagnosed with depression were mostly spread out between mild to moderately severe. This study further demonstrated that history of alcohol use and choice of hospital were crucial variables that were associated with the prevalence of depression in individuals. Routine screening of CKD/ESRD for depression and anxiety prior to starting haemodialysis is recommended.