Contents lists available at ScienceDirect Applied Nursing Research journal homepage: www.elsevier.com/locate/apnr Original article Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis Victoria Semaan a, ⁎ , Samar Noureddine b , Laila Farhood b a American University of Beirut Medical Center, Cairo Street, Beirut 1107 2020, Lebanon b American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon ARTICLE INFO Keywords: Anxiety Depression End-stage renal disease Hemodialysis Survey designs ABSTRACT Background: Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context. Objective: The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country. Design: A cross-sectional, descriptive design was used. Methods: Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions. Results: The majority of participants were married men over 60 years of age; 48% achieved high school edu- cation. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both con- ditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014). Conclusion: Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed. 1. Introduction “End-stage renal disease (ESRD) is defined as kidney failure suffi- ciently severe to require maintenance dialysis or kidney transplantation to maintain health or life” (Feroze, Martin, Reina-Patton, Kalantar- Zadeh, & Kopple, 2010, p.173). Maintenance dialysis includes two main types: hemodialysis (HD) and peritoneal dialysis (PD). As the disease progresses to requiring dialysis, patients start experiencing multiple losses including their kidney function, primary role in their family and job, physical function and mobility, tolerance to activities, and others. This change in the patients' way to control their life was found to predict depression (Cvengros, Christensen, & Lawton, 2005). Also, pa- tients start experiencing multiple stressors like dietary limitations, re- current hospitalizations, short life span confrontation, burden of de- bilitating illness (like anemia, bone disease, and others…) and treatment dependence (Chilcot, Wellsted, Da Silva-Gane, & Farrington, 2008; Feroze et al., 2010; Ma & Li, 2016; Mitema & Jaar, 2016). Moreover, patients with ESRD experience many debilitating symptoms, including fatigue, pruritus, insomnia and cramps, which affect ad- versely their quality of life (Bossola, Di Stasio, Giungi, Rosa, & Tazza, 2015; Ma & Li, 2016; Moledina & Perry Wilson, 2015; SuSel, Batycka- Baran, Reich, & Szepietowski, 2014). This combination of stressors and symptoms, in addition to the workload that the ESRD patients usually bring to their family and friends, can all be major contributors to in- creased rates of depression and anxiety (Cukor et al., 2008). The literature on depression and anxiety in the general population is much more than what is found in patients with renal disease. Studies in Lebanon about the prevalence of depression and anxiety in ESRD pa- tients are scarce. Although HD is the most commonly used treatment modality for ESRD patients, with an increase by 33% over 5 years (Lebanese Kidney Registry, 2013), only one published study on hemo- dialysis patients was identified (Macaron et al., 2014). The authors https://doi.org/10.1016/j.apnr.2018.07.009 Received 1 April 2018; Accepted 25 July 2018 ⁎ Corresponding author. E-mail address: vgs01@mail.aub.edu (V. Semaan). Applied Nursing Research 43 (2018) 80–85 0897-1897/ © 2018 Elsevier Inc. All rights reserved. T