Chronic failure is a global health problem that is associated with high morbidity and mortality [1]. It is estimated that by 2020, 1,200 people will develop chronic kidney failure per 1 million people [5].
People around them play a very important role in improving the quality of life of patients, and in the meantime, the role of the spouse is the most important. Spouse disease is a difficult and challenging issue for couples, and having a spouse with chronic kidney failure affects the couple's emotions. The health of spouses and patients is closely linked, and caregivers can play an important role in improving the health and well-being of their hemodialysis patients [11].
Depression is common in patients undergoing hemodialysis, and they have a lower quality of life. [12] It is important to pay attention to the mental health of other family members, not only to help treat and prevent recurrence of the disease, but also to improve the mental health of the community and prevent mental disorders in other family members. Studies show that the psychological state of other family members in different ways can affect the course of the disease and the treatment of the patient's illness [16]. The health of caregivers and patients is also closely linked. However, most studies have focused on the patient and the interaction between the patient and the family has received less attention from researchers. There is also little information about comparing the variables of depression and quality of life in patients and their spouses; therefore, the present study was conducted to compare the rate of depression and quality of life between patients under hemodialysis and their spouses.

 

The present study is an analytical-cross-sectional study that was conducted from July 2017 to September 2016. A total of 172 participants (86 patients under hemodialysis and 86 spouses) from two hospitals affiliated with Saveh University of Medical Sciences entered the study. The two hospitals are covered by Saveh School of Medical Sciences. Also, in this study, the entire research community entered the study as a census. Criteria for entering the study included having at least 6 months of dialysis, no history of chronic mental illness in the patient and their spouses, being able to speak Persian, no hearing problems, having a sick spouse as the patient's primary caregiver, and willingness to participate in research. The only criterion for leaving the research was the inability of participants to transfer information to the researcher. The tool used in this study was a three-part questionnaire, the first part of which included demographic information, the second part of the Beck-2 depression questionnaire, and the third part of the World Health Organization's Quality of Life Questionnaire.
Data analysis was performed using SPSS software version 19 (SPSS Inc., Chicago, Ill., USA) and independent t-test, independent Chi-square test were used. In order to comply with the researcher's ethical considerations, after stating the objectives of the study, written consent was obtained from the research samples and in the process of research, confidentiality and freedom of samples were observed to participate in research or exit. This study was approved with the code of ethics SAVEHUMS.REC.1396-006 in Saveh School of Medical Sciences.

 

A total of 172 people (86 patients under hemodialysis and 86 their spouses) participated in the study. The participants' demographic information was as follows: of the 86 patients participating in the study, 51.32% (45) were female and 48.68% (41) were male. The average age of the participants in the patients' group was 49.09 (standard deviation of 8.52) and in the group of spouses was 48.56 (standard deviation was 7.85). In terms of education, most patients (31.39%) and spouses (30.23%) had undergraduate education. The mean and standard deviation of patients' hemodialysis time was 5.86 years (standard deviation of 2.55).
Overall, 89.54% and 91.87% of dialysis patients and their spouses were depressed with varying severity (mild to severe), respectively. An independent t-test showed that the mean depression difference between the two groups was statistically significant (P=0.001). Also, Chi-square statistical test showed a statistically significant difference between the two groups of patients and spouses in terms of the severity of their depression (P<0.001). Table 1 compares the frequency, mean, and standard deviations of depression in patients undergoing hemodialysis and their spouses.

 
Table 1. Comparison of frequency, mean and standard deviation of depression in patients under hemodialysis and their spouses

Depression	Patients		Spouses		P
	N	%	N	%
No depression (0-13)	9	10.46	7	8.13
Mild (14-19)	35	40.69	30	34.88
Medium (20-28)	30	34.88	32	37.2
Severe (29-63)	12	13.95	17	19.76
Mean and standard deviation of the total score	8.09±23.59		7.19±27.75		(=0.001 P)

   

Areas of quality of life	Score range	Patients	Spouses	P
		M (SD)	M (SD)
Physical health	20-4	(2.1) 10.12	(2.02) 12.89	0.02
mental health	20-4	(2.51) 10.87	(3.05) 8.86	0.001
Community Relations	20-4	(2.7) 12.69	(2.4) 12.72	0.78
Environmental health	20-4	(2.99) 12.68	(3.14) 12.59	0.62
Overall quality of life	5-1	(0.49) 2.62	(0.55) 2.71	0.8
Health satisfaction	5-1	(0.56) 1.77	(0.62) 2.87	0.03

Comparison of the mean of the two groups showed a statistically significant difference in the areas of physical health, mental health and health satisfaction (P=0.001); thus, the mean score of mental health in the wives of dialysis patients was lower than the group of patients and the mean score of physical health and health satisfaction in patients under hemodialysis was lower than their spouses (P<0.05).

 

The results of this study showed that in addition to the effects of hemodialysis, it impairs the quality of life of patients in the physical, mental, social and environmental fields. Patients' spouses have not been immune to these effects and were even more depressed compared to their patients. Proper mental health will have a significant impact on the health and well-being of the chronic patient [23, 22]. However, the results showed that not only the spouses of patients who play an important care role are not in a good mood, but they are more depressed than their sick spouses.
In the present study, 89.54% of patients and 91.87% of their spouses had some degree of depression, which is much higher than in previous studies [24-26]; For example, according to research by Hawamdeh et al., 68.6% of patients and 53% of caregivers of patients with renal failure were depressed, which is very different from the results of the present study [26].
The results of Salehi Tali, Zarea and Hasanpour's research, which were conducted with a qualitative approach, also confirmed that the mental health of home care patients under hemodialysis is affected by the problems of hemodialysis patients, existing deficiencies during daily care and concerns; which leads to an increase in their mental state vulnerability [29].
The results of the present study showed that the rate of depression in the spouses group is higher than in the patients group. There are few studies comparing depression in patients with hemodialysis and their spouses. A study by Hawamdeh et al., that aimed to compare depression in patients with kidney failure and their caregivers, found that, contrary to the results of the present study, the rate of depression was higher than that of caregivers [26], which can be attributed to Cultural differences or even differences are rooted in the caregiver support system.
The findings of the present study on quality of life indicated that hemodialysis affects the quality of life of patients and their spouses at different levels. This finding is consistent with previous studies that have shown that the quality of life of dialysis patients in the areas of physical health, social functioning, energy level, general health and mental health is low [30,31].
This finding showed that it is very important to pay attention to the quality of life of patients' spouses in reflecting their health level [32]. It is necessary to provide care programs to increase the quality of life of patients and their spouses, and there is a need to pay attention to and address the existing challenges for this group [33].
 

Overall, the results indicated a high probability of depression in patients undergoing hemodialysis and their spouses, as well as a reduction in the quality of life in both groups. It also showed that the spouses of patients undergoing hemodialysis have higher levels of depression and lower quality of life in terms of mental health than patients. Spouses of patients undergoing hemodialysis are vulnerable individuals who need intervention, counseling, and follow-up over time, and nurses can play a significant role in this area.

 

This research was the result of a research project approved by Saveh School of Medical Sciences; therefore, we would like to thank all the patients under hemodialysis and their spouses who participated in this study.
 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.