Volume 28, Issue 2 (5-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(2): 136-143 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Baghcheghi N, Koohestani H R. Comparison of Depression and Quality of Life Between Patients on Hemodialysis and Their Spouses. Avicenna J Nurs Midwifery Care. 2020; 28 (2) :136-143
URL: http://nmj.umsha.ac.ir/article-1-2082-en.html
1- Assistant Professor, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
2- Assistant Professor, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran , Koohestani709@gmail.com
Full-Text [PDF 516 kb]   (358 Downloads)     |   Abstract (HTML)  (3554 Views)
✅ Depression is highly prevalent among patients on hemodialysis and their spouses. Spouses had higher rates of depression and lower quality of life in psychological health domain than patients. Therefore, it is suggested that, like patients, the depression and quality of life of their spouses should be assessed periodically and, if necessary, supportive measures should be taken.
Extended Abstract:   (187 Views)
Introduction

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.

 

Materials and Methods

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.


 

Results

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)
 
The mean scores of different areas of quality of life between patients and spouses were compared with independent t-test. The mean and standard deviation of the scores of different areas of participants' quality of life questionnaire and its P-values are given in Table 2.
 
Table 2. Comparison of the average score of the quality of life of patients under hemodialysis and their spouses
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).

 
Discussion

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].
 

Conclusion

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.

 

Acknowledgments

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.
 

Conflicts of Interest

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

 

Type of Study: Original Research | Subject: Nursing
Received: 2019/07/31 | Accepted: 2019/09/7 | Published: 2019/09/7

References
1. Ye JJ, Zhou TB, Zhang YF, Wang Q, Su YY, Tang JM, Li HY. Levels of vitamin D receptor and CYP24A1 in patients with end-stage renal disease. African health sciences. 2016;16(2):462-7. [DOI:10.4314/ahs.v16i2.14] [PMID] [PMCID]
2. IZADPANAH AM, HADAVI M, BAHRAMI TH. The effect of foot reflexology on severity of fatigue in haemodialysis patients.
3. Iranian Consortium of Dialysis. Calendar of Dialysis by the End of 2016. Annual data report: atlas of chronic kidney disease and end-stage renal disease in islamic repoblic of iran 1395 [Available from: http://www.icdgroup.org/Content/Upload/pdf/1395.pdf. (Persian)
4. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, AlMazroa MA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2012 Dec 15;380(9859):2095-128.
5. Zheng J, You LM, Lou TQ, Chen NC, Lai DY, Liang YY, Li YN, Gu YM, Lv SF, Zhai CQ. Development and psychometric evaluation of the Dialysis patient-perceived Exercise Benefits and Barriers Scale. International journal of nursing studies. 2010 Feb 1;47(2):166-80. [DOI:10.1016/j.ijnurstu.2009.05.023] [PMID]
6. Baghcheghi N, Ashktorab T, Seyedfatemi N. Relationship of Coping Strategies with Quality of Life in Women Living with Husband on Hemodialysis. Avicenna Journal of Nursing and Midwifery Care. 2017 Apr 10;25(1):9-17. [DOI:10.21859/nmj-25012]
7. Koohestani HR, Baghcheghi N. The prevalence of depression among caregivers of stroke survivors and related factors in Arak. Iranian Journal of Epidemiology. 2012 Dec 15;8(3):66-72.
8. Ashktorab T, Baghcheghi N, Seyedfatemi N, Baghestani A. Psychometric parameters of the Persian version of the BriefCOPE among wives of patients under hemodialysis. Medical journal of the Islamic Republic of Iran. 2017;31:20. [DOI:10.18869/mjiri.31.20]
9. Mollaei F, Borhani F, Abbaszadeh A, Khabazkhoob M. Correlation between spiritual well-being and burden of care in family caregivers of cancer patients. Hayat, Journal of School of Nursing and Midwifery, Tehran Universit Mollaei F, Borhani F, Abbaszadeh A, Khabazkhoob M. Correlation between spiritual well-being and burden of care in family caregivers of cancer patients. Journal of hayat. 2019 Jan 10;24(4):296-309.y of Medical Sciences. 2019;24(4):296-309. (Persian)
10. Adili D, Dehghani-Arani F. The relationship between caregiver's burden and patient's quality of life in women with breast cancer. Journal of Research in Psychological Health. 2018 Aug 10;10(2):30-9.
11. Calvin AO. Haemodialysis patients and end‐of‐life decisions: a theory of personal preservation. Journal of advanced nursing. 2004 Jun;46(5):558-66. [DOI:10.1111/j.1365-2648.2004.03030.x] [PMID]
12. Baghcheghi N, Koohestani HR. Quality of life of caregivers of elderly people with stroke at the hospitalization time and after leaving hospital, and its association with patients disabilities. Journal of Nursing and Midwifery. 2011;21(47):35-41. (Persian)
13. Shafaii M, Payami M, Amini K, Pahlevan S. The relationship between death anxiety and quality of life in hemodialysis patients. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences. 2017;22(4):325-38. (Persian)
14. Khaki S, Khesali Z, Farajzadeh M, Dalvand S, Moslemi B, Ghanei Gheshlagh R. The relationship of depression and death anxiety to the quality of life among the elderly population. Journal of hayat. 2017 Jul 15;23(2):152-61.
15. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues in clinical neuroscience. 2009 Jun;11(2):217.
16. Farajzadeh M, Hosseini M, Ghanei Gheshlagh R, Ghosi S, Nazari M, Nahid K. Investigating the association between Restless Leg Syndrome and depression in elderly. Iranian Journal of Rehabilitation Research. 2016 Jun 10;2(3):18-26. [DOI:10.17795/nmsjournal32585] [PMID] [PMCID]
17. Gheshlagh RG, Parizad N, Sayehmiri K. The relationship between depression and metabolic syndrome: systematic review and meta-analysis study. Iranian Red Crescent Medical Journal. 2016 Jun;18(6). [DOI:10.5812/ircmj.26523]
18. Beck AT, Steer RA, Brown G. Manual for the Beck depression inventory-II (BDI-II).
19. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian‐language version of the Beck Depression Inventory‐Second edition: BDI‐II‐PERSIAN. Depression and anxiety. 2005;21(4):185-92. [DOI:10.1002/da.20070] [PMID]
20. Skevington SM, Lotfy M, O'Connell K2. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of life Research. 2004 Mar 1;13(2):299-310. [DOI:10.1023/B:QURE.0000018486.91360.00] [PMID]
21. Nejat SA, Montazeri A, Holakouie Naieni K, Mohammad KA, Majdzadeh SR. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of School of Public Health and Institute of Public Health Research. 2006 Jul 15;4(4):1-2.
22. Mashayekhi F, Pilevarzadeh M, Rafati F. The assessment of caregiver burden in caregivers of hemodialysis patients. Materia socio-medica. 2015 Oct;27(5):333. [DOI:10.5455/msm.2015.27.333-336] [PMID] [PMCID]
23. Alnazly E. Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis. Saudi Journal of Kidney Diseases and Transplantation. 2016 Jan 1;27(1):101. [DOI:10.4103/1319-2442.174088] [PMID]
24. Turkmen K, Yazici R, Solak Y, Guney I, Altintepe L, Yeksan M, Tonbul HZ. Health‐related qualıty of lıfe, sleep qualıty, and depressıon in peritoneal dialysis and hemodıalysıs patıents. Hemodialysis International. 2012 Apr;16(2):198-206. [DOI:10.1111/j.1542-4758.2011.00648.x] [PMID]
25. Klaric D, Klaric V. Depression in end stage renal disease: comparison between patients treated with hemodialysis and peritoneal dialysis. Journal of Life Sciences. 2012 May 1;6(5).
26. Hawamdeh S, Almari AM, Almutairi AS, Dator WL. Determinants and prevalence of depression in patients with chronic renal disease, and their caregivers. International journal of nephrology and renovascular disease. 2017;10:183. [DOI:10.2147/IJNRD.S139652] [PMID] [PMCID]
27. Eghbali M, Shahqolian N, Nazari F, Babaee S. Comparing problems of patients with chronic renal failure undergoing hemodialysis and peritoneal dialysis referring to medical university's hospitals. Iranian Journal of Nursing and Midwifery Research. 2009 Apr 20;14(1).
28. Assefa B, Duko B, Ayano G, Mihretie G. Prevalence and factors associated with depressive symptoms among patient with Chronic Kidney Disease (CKD) in Black Lion Specialized Hospital and Saint Paulo's Hospital Millennium Medical College, Addis Ababa, Ethiopia: Cross Sectional Study. J Psychiatry. 2016;19(390):2. [DOI:10.4172/2378-5756.1000390]
29. Salehi Tali s, Zarea k, Hasanpour A. Victim of situation: experience familial caregiver with hemodialysis patient. A qualitative study. Journal of Clinical Nursing and Midwifery. 2018;7(2):158-69.
30. Shimoyama S, Hirakawa O, Yahiro K, Mizumachi T, Schreiner A, Kakuma T. Health-related quality of life and caregiver burden among peritoneal dialysis patients and their family caregivers in Japan. Peritoneal Dialysis International. 2003 Dec 1;23(Supplement 2):S200-5. [DOI:10.1177/089686080302302s42]
31. Alvarez-Ude F, Valdés C, Estébanez C, Rebollo P. Health-related quality of life of family caregivers of dialysis patients. Journal of Nephrology. 2004;17(6):841-50. [DOI:10.1016/S1098-3015(10)67763-7]
32. Daneker B, Kimmel PL, Ranich T, Peterson RA. Depression and marital dissatisfaction in patients with end-stage renal disease and in their spouses. American journal of kidney diseases. 2001 Oct 1;38(4):839-46. [DOI:10.1053/ajkd.2001.27704] [PMID]
33. Habibzadeh H, Mohammadpour Y, Jafarizadeh H, Kiani P, Bahrechi A, Lak KH. A survey on quality of life in hemodialysis patient care givers. The Journal of Urmia Nursing and Midwifery Faculty. 2009;7(3):128-35.

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2021 CC BY-NC 4.0 | Avicenna Journal of Nursing and Midwifery Care

Designed & Developed by : Yektaweb