Depression In Maintenance Hemodialysis Patients And Its Influence Factors

BackgroundThe chronic kidney disease,due to the high incidence,the increases of the prevalence rate year by year,the burden of the treatment cost,the poor prognosis,and serious threat to physical health,has become a public health hotspot of global concern.But maintenance hemodialysis is a major alternative therapies.On account of vivo metabolite accumulation for a long time,electrolyte and acid-base balance disorder,it causes a series of physical symptoms,such as impaired digestion and absorption,joint pain and sleep disorders.Combined with the professional ability,social support,the burden of medical fee,it causes depression and other emotional disorders of maintenance hemodialysis patients.Therefore,it is of great theoretical and practical significance to pay attention to the development mechanism of depression in maintenance hemodialysis patients.Objective1.To get theoretical research evidence related to depression through investigation of the prevalence rate of depression in maintenance hemodialysis patients and distribution of basic information;2.To study the relationship among the negative automatic thoughts,social support;and depression in maintenance hemodialysis patients and analyze their interactive mechanism of action to provide theoretical support for improving the depression.MethodThis study is from June 2015 to 2017,and the subjects are 180 patients undergoing routine hemodialysis in the department of nephrology blood purification center in four hospitals from xinxiang city,henan province.According to the inclusion criteria:(1)Above18 years of age;(2)For more than three months of dialysis;(3)During the experiment,the patient was relatively stable;(4)With clear consciousness and normal intelligence,it can understand the content of the survey and participate in the research voluntarily.Exclusion criteria:(1)There was a clear history of major psychiatric illnesses such as severe depression and schizophrenia;(2)To clarify the serious cardiovascular and cerebrovascular diseases,or malignant tumors;(3)The function of the liver was clear.(4)In the past three months,acute infection,trauma,blood transfusion,surgery;(5)The diagnosis is common diseases such as alzheimer's disease and chronic bronchitis.There are 93 males and 87females,whose ages range from 23 to 84 years old,with an average age of 49.86±13.291.The Social Support Rating Scale(SSRS),the Automatic Thoughts Questionnaire(ATQ)and the Self-Rating Depression Scale(SDS)was used to measure 180 inpatients and 195normal person.Epidata 3.1 is used to collect the data and establish a database;SPSS17.0.and AMOS 22.0 is used to do data statistics/analysis,the number of cases and percentage is used to do count data.The measurement data is collected through mean and standard deviation.An independent samples t test,variance analysis,one-way ANOVA,pearson correlation analysis,and path analysis are conducted.The test level is taken as?=0.05(bilateral inspection).Result1.According to the results of SDS,143 people are with depressive symptoms in the questionnaire survey in maintenance hemodialysis patients,accounting for 79.44%of the total number of patients with maintenance hemodialysis.Among them,65 are mild depressive symptoms,accounting for 36.11 percent of the total.There are 78 patients with major depressive symptoms,accounting for 43.33%of the total number in maintenance hemodialysis patients.There are only 37 people with no depressive symptoms,accounting for 20.56 percent of total hemodialysis patients.2.The prevalence of depression in maintenance hemodialysis patients is significantly different in different degrees of cultures,household income per month and monthly dialysis frequency(?~2=15.987,P=0.003;?~2=30.902,P<0.001;?~2=9.647,P=0.047).3.The subjective support of the group with the age from35 to50 is significantly higher than the group under 35 years old(P=0.013).Depression and negative automatic thinking of urban residents are significantly higher than those in rural areas(P=0.007,P=0.026);The social support of urban residents and their objective support and subjective support are significantly lower than that of rural residents(P=0.009,P=0.043,P=0.029).The scores of depression in families with a monthly income less than 1000 yuan per capita and the families with a monthly income from 1000 to 3000 yuan are significantly higher than those in families with a monthly income of more than 3,000 yuan(P<0.001).The number of patients with dialysis at least 12 times per month and the number of dialysis patients between 8 and 12 times is significantly higher than those with less than 8 dialysis times per month(P=0.028,P=0.036).4.The high negative automatic thinking are more depressed than those with low negative automatic thinking.Low social support for maintenance hemodialysis patients scored significantly higher than those with high social support.5.The hemoglobin in hemodialysis patients with moderate-severe depression are significantly lower than those with no depressive symptoms(P=0.003).The albumin in patients with mild depression and moderate-severe depression are significantly lower than those without depression(P=0.014,P=0.001).6.The depression scores of Maintenance hemodialysis patients are positively related to the scores of negative automatic thinking,but have significantly negative correlation with the scores of social support,objective support,subjective support,and the utilization of support;The scores of negative automatic thinking are negatively correlated with the scores of social support,objective support,subjective support and utilization of support.The scores of social support are positively correlated with the scores of objective support,subjective support and utilization of support.7.By constructing the path model of the relationship between the depression status of maintenance hemodialysis patients and the negative automatic thinking and social support,it is concluded that the direct effect of social support on depression is-0.39,and negative automatic thoughts play a partial intermediary role in the relation between social support and depression of maintenance hemodialysis patients,the number being-0.138,accounting for 35.38%of the total effect.Conclusion1.The prevalence of depression was higher in maintenance hemodialysis patients.2.A relatively low degrees of cultures,the lower household income per month and the higher dialysis frequency will lead to the higher prevalence of depression in maintenance hemodialysis patients.3.The lower the level of hemoglobin and albumin in the patients with maintenance hemodialysis,the higher the degree of disease.4.The negative automatic thoughts play a partial intermediary role in the relation between social support and depression of maintenance hemodialysis patients.Negative automatic thinking has positive prediction function on depression in maintenance hemodialysis patients,but social support has negative prediction function.It is suggested to understand and eliminate the negative automatic thinking and increase social support of maintenance hemodialysis patients can reduce the risk of depression in maintenance hemodialysis patients.