The influence of socioeconomic factors on depression in maintenance hemodialysis patients and their caregivers

Aim: Depression has a strong impact on the quality of life of patients receiving maintenance hemodialysis (MHD). The objective of this study was to analyze the factors influencing the depression scores of MHD patients and their primary caregivers. Methods: 141 patients (54 female, aged 53.6 +/- 14.2 years) who had been on MHD for at least 3 months were included. Age, gender, etiology of renal disease, duration of dialysis, marital and employment status, and income and living status of patients were recorded from patient charts and through face-to-face interviews. Disability was assessed by a selfadministered questionnaire. Additionally, 40 of the 141 patients (28%) primary caregivers were interviewed face-to-face. All patients and 40 primary caregivers were evaluated for the presence of depressive symptoms by Beck Depression Inventory (BDI). Results: Moderate-to-severe depressive symptoms were found in 36.2% of the study group. Divorced patients were significantly more depressed (p < 0.02) than married or single patients. Patients living with and being cared for by their nuclear family (father, mother, and/or children) were less depressed than patients being cared for by other relatives (p < 0.009). Monthly income was negatively correlated with both patients' and primary caregivers' BDI score (p < 0.005). Patients with high disability scores were more depressed than nondisabled patients (p < 0.08). Primary caregivers' BDI scores were positively correlated with the patients' BDI scores (p < 0.0001). Binary logistic regression analysis revealed that higher depression scores were significantly associated with more than 3 children under guardianship (p < 0.01) and higher disability scores (p < 0.023). Conclusion: In this present study, we observed that economically, socially, and physically self-sufficient MHD patients had lower depression rates. The treatment of depression and social and psychological support for both the patient and the family members are essential for better medical status among MED patients.