Background
Methods
HADS questionnaire
Administration of the HADS
Study design and setting
Data collection
Scoring
Statistical analysis
Results
Socio-demographic characteristics of patients evaluated for depression level
Variables | No. (%) |
---|---|
Gender | |
Female | 98 (45.5) |
Male | 122 (55.5) |
Age mean (±SD) | 56.58 (± 11.09) |
Age group (years) | |
< 40 | 17 (7.7) |
41–60 | 130 (59.1) |
> 60 | 73 (33.2) |
BMI mean (±SD) | 23.57 (± 4.31) |
BMI Classification | |
Underweight | 12 (5.5) |
Normal | 148 (67.3) |
Overweight | 46 (20.9) |
Obese | 14 (6.4) |
Socioeconomic Status | |
Low | 39 (17.7) |
Middle | 155 (70.5) |
High | 26 (11.8) |
Education Level | |
Uneducated | 74 (33.6) |
Educated | 146 (66.4) |
Marital Status | |
Single | 18 (8.2) |
Married | 202 (91.8) |
Race | |
Malay | 212 (96.4) |
Others | 8 (3.6) |
Smoking Status | |
Current Smoker | 73 (33.2) |
Non-Smoker | 147 (66.8) |
Alcohol | |
Current drinker | 18 (8.2) |
Non-drinker | 202 (91.8) |
Drug Addiction | |
Current Drug Addiction | 35 (15.9) |
No Drug Addiction | 185 (84.1) |
Employment | |
Unemployed | 120 (54.5) |
Employed | 100 (45.5) |
Dialysis Years | |
1 year | 62 (28.2) |
2–4 years | 78 (35.5) |
> 5 years | 80 (36.4) |
Hemodialysis Centers | |
Private | 129 (58.6) |
NGO | 33 (15) |
Governmental | 58 (26.4) |
Vascular access | |
Fistula | 204 (92.7) |
Others | 16 (7.3) |
Hypertension | |
No | 18 (8.2) |
Yes | 202 (91.8) |
Diabetes Mellitus | |
No | 81 (36.8) |
Yes | 139 (63.2) |
Cardiovascular Diseases | |
No | 185 (84.1) |
Yes | 35 (15.9) |
Predictors of prevalence of depression among hemodialysis patients at baseline visit
Variables | Prevalence of Depression (No. %) | Univariate analysis OR (95% CI) | P-value | Multivariate analysis OR (95% CI) | P-value | |
---|---|---|---|---|---|---|
No | Yes | |||||
Gender | ||||||
Female | 23 (23.4) | 75 (76.6) | Referent | Referent | ||
Male | 40 (32.8) | 82 (67.2) | 0.690 (0.380–1.254) | 0.224 | 0.742 (0.399–1.383) | 0.348 |
Age (years) | ||||||
< 40 | 4 (23.5) | 13 (76.5) | Referent | |||
41–60 | 40 (30.8) | 90 (69.2) | 0.692 (0.213–2.255) | 0.542 | ||
> 60 | 19 (26) | 54 (74) | 0.874 (0.254–3.012) | 0.832 | ||
BMI | ||||||
Underweight | 4 (33.3) | 8 (66.7) | Referent | |||
Normal | 41 (27.7) | 107 (72.3) | 1.305 (0.373–4.568) | 0.677 | ||
Overweight | 11 (23.9) | 35 (76.1) | 1.591 (0.401–6.313) | 0.509 | ||
Obese | 7 (50) | 7 (50) | 0.500 (0.102–2.460) | 0.394 | ||
Socioeconomic Status | ||||||
Low | 13 (33.3) | 26 (66.7) | Referent | Referent | ||
Middle | 37 (23.9) | 118 (76.1) | 1.595 (0.745–3.414) | 0.230 | 1.826 (0.816–4.086) | 0.143 |
High | 13 (50) | 13 (50) | 0.500 (0.181–1.382) | 0.182 | 0.570 (0.194–1.677) | 0.307 |
Marital Status | ||||||
Single | 4 (22.2) | 14 (77.8) | Referent | |||
Married | 59 (29.2) | 143 (70.8) | 0.692 (0.219–2.191) | 0.532 | ||
Race | ||||||
Malay | 62 (29.2) | 150 (70.8) | Referent | |||
Others | 1 (12.5) | 7 (87.5) | 2.893 (0.349–24.011) | 0.325 | ||
Smoking status | ||||||
Current Smoker | 21 (28.8) | 52 (71.2) | Referent | |||
Non-Smoker | 42 (28.6) | 105 (71.4) | 1.010 (0.543–1.877) | 0.976 | ||
Alcohol | ||||||
Current drinker | 6 (33.3) | 12 (66.7) | Referent | |||
Non-drinker | 57 (28.2) | 145 (71.8) | 1.272 (0.456–3.551) | 0.646 | ||
Drug Addiction | ||||||
Current Drug Addiction | 8 (22.9) | 27 (77.1) | Referent | |||
No Drug Addiction | 55 (29.7) | 130 (70.3) | 0.700 (0.299–1.638) | 0.411 | ||
Employment | ||||||
Unemployed | 32 (26.7) | 88 (73.3) | Referent | |||
Employed | 31 (31) | 69 (69) | 0.809 (0.451–1.454) | 0.479 | ||
Dialysis Years | ||||||
1 year | 23 (37.1) | 39 (62.9) | Referent | |||
2–4 years | 21 (26.9) | 57 (73.1) | 1.601 (0.781–3.283) | 0.299 | ||
> 5 years | 19 (23.8) | 61 (76.3) | 1.893 (0.914–3.923) | 0.686 | ||
Hemodialysis Centers | ||||||
Private | 29 (22.5) | 100 (77.5) | Referent | Referent | ||
NGO | 12 (36.4) | 21 (63.6) | 0.508 (0.223–1.153) | 0.105 | 0.413 (0.173–0.985) | 0.046 |
Governmental | 22 (37.9) | 36 (62.1) | 0.475 (0.242–0.930) | 0.030 | 0.522 (0.248–1.100) | 0.087 |
Vascular access | ||||||
Fistula | 59 (28.9) | 145 (71.1) | Referent | |||
Others | 4 (25) | 12 (75) | 1.221 (0.378–3.938) | 0.739 | ||
Diabetes Mellitus | ||||||
No | 23 (28.4) | 58 (71.6) | Referent | 0.952 | ||
Yes | 40 (28.8) | 99 (71.2) | 0.981 (0.535–1.800) | |||
Cardiovascular Diseases | ||||||
No | 55 (29.7) | 130 (70.3) | Referent | |||
Yes | 8 (22.9) | 27 (77.1) | 1.428 (0.611–3.339) | 0.411 | ||
Gouty Arthritis | ||||||
No | 56 (29.3) | 135 (70.7) | Referent | |||
Yes | 7 (24.1) | 22 (75.9) | 1.304 (0.527–3.225) | 0.566 | ||
Other Comorbidities | ||||||
No | 44 (28.2) | 112 (71.8) | Referent | |||
Yes | 19 (29.7) | 45 (70.3) | 0.930 (0.491–1.764) | 0.825 | ||
Type Therapy | ||||||
Mono-therapy | 30 (24.8) | 91 (75.2) | Referent | Referent | ||
Multi-therapy | 33 (33.3) | 66 (66.7) | 0.659 (0.366–1.186) | 0.164 | 0.553 (0.293–1.043) | 0.067 |
Predictors of prevalence of depression among hemodialysis patients at 2nd visit
Variables | Prevalence of Depression (No. %) | Univariate analysis OR (95% CI) | P-value | Multivariate analysis OR (95% CI) | P-value | |
---|---|---|---|---|---|---|
No | Yes | |||||
Gender | ||||||
Female | 17 (17.3) | 81 (82.7) | Referent | |||
Male | 30 (25.4) | 88 (74.6) | 0.676 (0.351–1.336) | 0.245 | 0.699 (0.357–1.370) | 0.297 |
Age (years) | ||||||
< 40 | 3 (17.6) | 14 (82.4) | Referent | |||
41–60 | 28 (22) | 99 (78) | 0.758 (0.203–2.824) | 0.679 | ||
> 60 | 16 (22.2) | 56 (77.8) | 0.750 (0.192–2.937) | 0.680 | ||
BMI | ||||||
Underweight | 4 (33.3) | 8 (66.7) | Referent | |||
Normal | 28 (19.2) | 118 (80.8) | 2.107 (0.592–7.496) | 0.250 | ||
Overweight | 10 (22.2) | 35 (77.8) | 1.750 (0.436–7.032) | 0.430 | ||
Obese | 5 (38.5) | 8 (61.5) | 0.800 (0.155–4.123) | 0.790 | ||
Socioeconomic Status | ||||||
Low | 10 (25.6) | 29 (74.4) | Referent | |||
Middle | 29 (19.1) | 123 (80.9) | 1.463 (0.641–3.337) | 0.366 | ||
High | 8 (32) | 17 (68) | 0.733 (0.243–2.214) | 0.582 | ||
Marital Status | ||||||
Single | 3 (16.7) | 15 (83.3) | Referent | |||
Married | 44 (22.2) | 154 (77.8) | 0.700 (0.194–2.528) | 0.586 | ||
Race | ||||||
Malay | 47 (22.6) | 161 (77.4) | Non-computable | |||
Others | – | 8 (100) | – | |||
Smoking status | ||||||
Current Smoker | 15 (21.1) | 56 (78.9) | Referent | |||
Non-Smoker | 32 (22.1) | 113 (77.9) | 0.946 (0.474–1.889) | 0.875 | ||
Alcohol | ||||||
Current drinker | 4 (23.5) | 13 (76.5) | Referent | |||
Non-drinker | 43 (21.6) | 156 (78.4) | 1.116 (0.346–3.598) | 0.854 | ||
Drug Addiction | ||||||
Current Drug Addiction | 7 (20.6) | 27 (79.4) | Referent | |||
No Drug Addiction | 40 (22) | 142 (78) | 0.920 (0.373–2.269) | 0.857 | ||
Employment | ||||||
Unemployed | 23 (19.7) | 94 (80.3) | Referent | |||
Employed | 24 (24.2) | 75 (75.8) | 0.765 (0.400–1.461) | 0.417 | ||
Dialysis Years | ||||||
1 year | 15 (24.6) | 46 (75.4) | Referent | |||
2–4 years | 18 (23.7) | 58 (76.3) | 1.051 (0.478–2.308) | 0.902 | ||
> 5 years | 14 (17.7) | 65 (82.3) | 1.514 (0.667–3.439) | 0.322 | ||
Hemodialysis Centers | ||||||
Private | 23 (18.4) | 102 (81.6) | Referent | Referent | ||
NGO | 10 (30.3) | 23 (69.7) | 0.519 (0.217–1.237) | 0.139 | 0.580 (0.238–1.412) | 0.580 |
Governmental | 14 (24.1) | 44 (75.9) | 0.709 (0.334–1.504) | 0.370 | 0.646 (0.295–1.417) | 0.276 |
Vascular access | ||||||
Fistula | 44 (22) | 156 (78) | Referent | |||
Others | 3 (18.8) | 13 (81.3) | 1.222 (0.333–4.481) | 0.762 | ||
Diabetes Mellitus | ||||||
No | 14 (17.3) | 67 (82.7) | Referent | Referent | ||
Yes | 33 (24.4) | 102 (75.6) | 0.646 (0.322–1.297) | 0.219 | 0.688 (0.335–1.413) | 0.309 |
Cardiovascular Diseases | ||||||
No | 40 (22) | 142 (78) | Referent | |||
Yes | 7 (20.6) | 27 (79.4) | 1.087 (0.441–2.679) | 0.857 | ||
Gouty Arthritis | ||||||
No | 43 (22.9) | 145 (77.1) | Referent | |||
Yes | 4 (14.3) | 24 (85.7) | 1.779 (0.585–5.409) | 0.310 | ||
Other Comorbidities | ||||||
No | 35 (22.9) | 118 (77.1) | Referent | |||
Yes | 12 (19) | 51 (81) | 1.261 (0.605–2.625) | 0.536 | ||
Type Therapy | ||||||
Mono-therapy | 22 (18.5) | 97 (81.5) | Referent | Referent | ||
Multi-therapy | 25 (25.8) | 72 (74.2) | 0.653 (0.341–1.250) | 0.198 | 0.628 (0.319–1.237) | 0.178 |
Predictors of prevalence of depression among hemodialysis patients at final visit
Variables | Prevalence of Depression (No. %) | Univariate analysis OR (95% CI) | P-value | Multivariate analysis OR (95% CI) | P-value | |
---|---|---|---|---|---|---|
No | Yes | |||||
Gender | ||||||
Female | 13 (13.7) | 82 (86.3) | Referent | |||
Male | 19 (16.1) | 99 (83.9) | 0.826 (0.385–1.773) | 0.624 | ||
Age (years) | ||||||
< 40 | 2 (11.8) | 15 (88.2) | Referent | |||
41–60 | 20 (15.6) | 108 (84.4) | 0.720 (0.153–3.394) | 0.678 | ||
> 60 | 10 (14.7) | 58 (85.3) | 0.773 (0.153–3.911) | 0.756 | ||
BMI | ||||||
Underweight | 4 (40) | 6 (60) | Referent | Referent | ||
Normal | 20 (13.9) | 124 (86.1) | 4.133 (1.071–15.951) | 0.039 | 3.339 (0.833–13.376) | 0.089 |
Overweight | 5 (11.1) | 40 (88.9) | 5.333 (1.110–25.636) | 0.037 | 4.205 (0.834–21.187) | 0.082 |
Obese | < 5 | 11 (78.6) | 2.444 (0.405–14.748) | 0.330 | 1.907 (0.300–12.123) | 0.494 |
Socioeconomic Status | ||||||
Low | 6 (15.8) | 32 (84.2) | Referent | |||
Middle | 20 (13.4) | 129 (86.6) | 1.209 (0.449–3.258) | 0.707 | ||
High | 6 (23.1) | 20 (76.9) | 0.625 (0.177–2.208) | 0.465 | ||
Marital Status | ||||||
Single | 2 (11.1) | 16 (88.9) | Referent | |||
Married | 30 (15.4) | 165 (84.6) | 0.688 (0.150–3.145) | 0.629 | ||
Race | ||||||
Malay | 32 (15.6) | 173 (84.4) | Non-computable | |||
Others | – | 8 (100) | – | |||
Smoking status | ||||||
Current Smoker | 12 (16.4) | 61 (83.6) | Referent | |||
Non-Smoker | 20 (14.3) | 120 (85.7) | 1.180 (0.541–2.573) | 0.677 | ||
Alcohol | ||||||
Current drinker | 2 (11.1) | 16 (88.9) | Referent | |||
Non-drinker | 30 (15.4) | 165 (84.6) | 0.688 (0.150–3.145) | 0.629 | ||
Drug Addiction | ||||||
Current Drug Addiction | 5 (14.3) | 30 (85.7) | Referent | |||
No Drug Addiction | 27 (15.2) | 151 (84.8) | 0.932 (0.332–2.615) | 0.894 | ||
Employment | ||||||
Unemployed | 17 (14.4) | 101 (85.6) | Referent | |||
Employed | 15 (15.8) | 80 (84.2) | 0.898 (0.422–1.908) | 0.779 | ||
Dialysis Years | ||||||
1 year | 10 (16.9) | 49 (83.1) | Referent | |||
2–4 years | 13 (17.6) | 61 (82.4) | 0.958 (0.387–2.370) | 0.925 | ||
> 5 years | 9 (11.3) | 71 (88.8) | 1.610 (0.610–4.253) | 0.337 | ||
Hemodialysis Centers | ||||||
Private | 13 (10.4) | 112 (89.6) | Referent | Referent | ||
NGO | 8 (25.8) | 23 (74.2) | 0.334 (0.124–0.897) | 0.030 | 0.347 (0.127–0.949) | 0.039 |
Governmental | 11 (19.3) | 46 (80.7) | 0.485 (0.203–1.162) | 0.105 | 0.487 (0.196–1.205) | 0.120 |
Vascular access | ||||||
Fistula | 29 (14.6) | 169 (85.4) | Referent | |||
Others | 3 (20) | 12 (80) | 0.686 (0.182–2.583) | 0.578 | ||
Diabetes Mellitus | ||||||
No | 9 (11.7) | 68 (88.3) | Referent | |||
Yes | 23 (16.9) | 113 (83.1) | 0.650 (0.284–1.487) | 0.308 | ||
Cardiovascular Diseases | ||||||
No | 29 (16.2) | 150 (83.8) | Referent | |||
Yes | 3 (8.8) | 31 (91.2) | 1.998 (0.572–6.973) | 0.278 | ||
Gouty Arthritis | ||||||
No | 30 (16.3) | 154 (83.7) | Referent | Referent | ||
Yes | 2 (6.9) | 27 (93.1) | 2.630 (0.594–11.653) | 0.203 | 2.637 (0.577–12.056) | 0.211 |
Other Comorbidities | ||||||
No | 24 (16) | 126 (84) | Referent | |||
Yes | 8 (19) | 55 (87.3) | 1.310 (0.554–3.096) | 0.539 | ||
Type Therapy | ||||||
Mono-therapy | 16 (13.8) | 100 (86.2) | Referent | |||
Multi-therapy | 16 (16.5) | 81 (83.5) | 0.810 (0.382–1.719) | 0.583 |
Discussion
Strengths and limitations of the study
-
This study involved a group of patients from tertiary-level teaching hospital of Malaysia.
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To the best of the authors’ knowledge, this is the first follow up study to assess the prevalence and predictors of depression among hemodialysis patients in a Malaysian setting.
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For determining the factors associated with depression, multivariate analysis was conducted.
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Being a prospective observational study, the findings of the present study need to be interpreted with caution since it is limited to only 6 months follow up.
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Nevertheless, a multicenter study with a large sample size and longer follow up time is needed to confirm the findings of the current study.