COVID-19 pandemic: depression and sleep quality in hemodialysis patients

Year 2022, Volume: 5 Issue: 2, 573 - 578, 15.03.2022

Demet Yavuz , Ayşe Pınar Doğru Balakbabalar , Mehmet Derya Demirag , Siren Sezer

https://doi.org/10.32322/jhsm.1054899

Abstract

Introduction: Depression and sleep disturbance are prevalent comorbidities in hemodialysis patients. This study aimed to investigate the relationship between depressive mood, sleep disturbance, and the fear of COVID-19 Scale in hemodialysis patients during the pandemic process.
Material and Method: 116 hemodialysis patients followed up in our clinic and volunteered were included in the study. The socio-demographic characteristics of the patients and the laboratory test results studied in their routine follow-ups were obtained from the file records. Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and the Fear of COVID-19 Scale (FCV-19S) were applied through face-to-face interviews.
Results: 116 patients (70 males, 46 females) with a hemodialysis duration of 40 months (13-295) and age of 60.2±13.3 years were included in the study. The patients were divided into two groups according to their PSQI score as good sleeper (PSQI ≤ 5, n=66) and poor sleeper (PSQI >5, n=50). When evaluated by gender 28 (56%) female patients were in the poor sleeper group (p=0.002). Dialysis time was longer, BDI score and FCV-19 scale were higher in the poor sleeper group than the good sleeper group. PSQI score was positively correlated with dialysis time (r=0.259 p=0.005), BDI score (r=0.279 p=0.002), and FCV-19 scale (r=0.304 p=0.001). In the Multiple Logistic Regression analysis established to evaluate the risk factors affecting sleep quality, BDI was determined as an independent risk factor for poor sleep (OR: 1.084, 95%CI [1.021-1.152], p=0.008). Subjects were divided into two groups according to their BDI scores as those with depressive mood (BDI score ≥ 17, n=47) (40.5%) and those without (BDI score < 17, n=69) (59.5%). Thirty-two of the cases with depressive mood were women (68.1%) (p<0.001). There was a female predominance in the depressed patient group. The economic status was worse in the depressed group compared to the non-depressed group, and the PSQI score and FVC-19 scale were higher. In addition, BDI score was positively correlated with age (r=0.225 p =0.015), female gender (r=0.473 p=0.001), poor economic status (r=0.576 p =0.001), FVC-19 scale (r=0.330 p =0.001), while negatively correlated with serum albumin level (r=-0.279 p=0.003) and serum creatinine level (r=-0.2455 p =0.008). In the Multiple Logistic Regression model established, female gender (OR: 7.857, 95%CI [2.463-25.065], p<0.001) and poor economic status (OR: 7.569, 95%CI [2,300-24,908], p=0.001) were determined as independent risk factors for depressive mood.
Conclusion: Nearly half of the patients had sleep disorders and depressive mood. Patients in the depressive mood and poor sleep group had a higher FVC-19 scale. We think it would be beneficial not to ignore the increased frequency of depressive mood and sleep disorders in hemodialysis patients during the COVID-19 pandemic.

Keywords

Depression, sleep disorder, Fear of Covid-19 Scale, hemodialysis

References

• Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The novel coronavirus 2019 epidemic and kidneys. Kidney Int 2020; 97: 824–8.
• Xiang Y T, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020; 7: 228–9.
• Lopes AA, Bragg J, Young E, et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002; 62: 199–207.
• Watnick S, Kirwin P, Mahnensmith R, Concato J. The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis 2003; 41: 105–10.
• Davison SN, Levin A, Moss AH, et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int 2015; 88: 447–59.
• Elder SJ, Pisoni RL, Akizawa T, et al. Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2008; 23: 998–1004.
• Lindner AV, Novak M, Bohra M, Mucsi I. Insomnia in patients with chronic kidney disease. Semin Nephrol 2015; 35: 359–72.
• Ikizler TA. COVID-19 and dialysis units: what do we know now and what should we do? Am J Kidney Dis 2020; 76: 1–3.
• Richter P, Werner J, Heerlein A, Kraus A, Sauer H. On the validity of the Beck Depression Inventory. A review Psychopathology 1998; 31: 160-8.
• Hisli N. Beck Depresyon Envanteri’nin geçerliliği üzerine bir çalışma. Psikoloji Derg 1998; 6: 118–22.
• Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. Pittsburgh Uyku Kalitesi İndeksi: Psikiyatrik uygulama ve araştırma için yeni bir araç. Psikiyatri Araş 1989; 28 : 193–213.
• Ladikli N, Bahadır E, Yumusak F, Akkuzu H, Karaman G, Turkkan Z. Uluslararası Sosyal Bilimler Derg 2020; 3: 71-80.
• Malta M, Rimoin AW, Strathdee SA. The coronavirus 2019-nCoV epidemic: is hindsight 20/20? E Clin Med 2020; 20: 100289.
• Ornell F, Schuch BJ, Sordi AO, Kessler FHP. Pandemic fear" and COVID-19: mental health burden and strategies. Braz J Psychiatry 2020; 42: 232-5.
• Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci 2020; 74: 281-2.
• Cohen LM, Dobscha SK, Hails KC, et al. Depression and suicidal ideation in patients who discontinue the life-support treatment of dialysis. Psychosom Med 2002; 64: 889–96.
• Chilcot J, Wellsted D, Da Silva-Gane M, Farrington K. Depression on dialysis. Nephron Clin Pract 2008; 108: 256-64.
• Chen CK , Tsai YC, Hsu HJ, et al. Depression and suicide risk in hemodialysis patients with chronic renal failure Psychosomatics Nov-Dec 2010; 51: 528.
• Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912–20.
• Umucu E, Lee B. Examining the impact of COVID-19 on stress and coping strategies in individuals with disabilities and chronic conditions. Rehabil Psychol 2020; 65: 193–8.
• Naamani AZ, Gormley K, Noble H, Santin O, Maqbali MA. Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrol 2021; 22: 157.
• Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant 2006; 21: 184–90.
• Bilgic A, Akgul A, Sezer S, Arat Z, Ozdemir FN, Haberal M. Nutritional status and depression, sleep disorder, and quality of life in hemodialysis patients. J Ren Nutr 2007; 17: 381-8.
• Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res 2020; 288: 112954.
• Gamaldo CE, Shaikh AK, McArthur JC. The sleep-immunity relationship. Neurol Clin 2012; 30: 1313–43.
• Xiao H, Zhang Y, Kong D. Social Capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit 2020; 26: 921–3.
• Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: the importance of gender. Int J Soc Psychiatr 2020; 66: 504–11.
• Koch BC, Nagtegaal JE, Hagen EC, et al. The effects of melatonin on sleep-wake rhythm of daytime haemodialysis patients: a randomized, placebo-controlled, crossover study (EMSCAP study) Br J Clin Pharmacol 2009; 67: 68–75.
• Dhabhar F.S. Enhancing versus suppressive effects of stres on immune function: implications for immunoprotection and immunpathology. Neuroimmunomodulation 2009; 16: 300–317.
• Akbulut H, İçli F, Büyükçelik A. The role of granulocyte-macrophage-colony stimulating factor, cortisol, and melatoninin the regulation of the circadian rhythms of peripheral blood cells in healthy volunteers and patients with breast cancer. J Pineal Res 1999; 26: 1–8.
• Akıncı T , Başar HM. Relationship between sleep quality and the psychological status of patients hospitalised with COVID-19 Sleep Med 2021; 80: 167-70.