Association between stress/anxiety, depression, pain and quality of life in people with chronic kidney disease.

Abstract

Objectives (s): To determine the prevalence of stress/anxiety and depression in people with chronic kidney disease and to verify the association between stress/anxiety and depression with pain and quality of life. Method: A cross-sectional, descriptive and correlational study. A representative sample of 183 people with Chronic Kidney Disease who underwent hemodialysis in two clinics and one hospital unit in the region of Lisbon, Portugal, was obtained. Data was collected from March to June 2015. The data collection instrument consisted of sociodemographic and health variables and the Depression Anxiety and Stress Scale (DASS-21) (Sousa et al., 2017) and Brief Pain Inventory, and SF 12 (Sousa, Marques-Vieira, Severino, Pozo-Rosado, & José, 2017). The DASS 21 in patients Chronic Kidney Disease has a two-dimensional model "Depression" and "Stress / Anxiety" with valid and reproducible measurements. The cut-off scores have been developed for defining mild/moderate/severe/extremely severe scores for each DASS scale. For the study of the association the Pearson correlation coefficient was used. The level of significance adopted was p <0.05. This study was approved by the Ethics Committee of the two health organizations. Results: The prevalence of Stress and Anxiety is 24% and depression is 37.2%. Stress and anxiety had a significant positive correlation with depression (r = 0.729, p <0.001) with pain severity (r = 0.243, p <0.05) and pain interference (r = 0.508, p <0.001) and negative with the physical (r = -0.167, p <0.05) and mental (r = -0.477; p <0.001) components of quality of life. Depression was positively and significantly associated with pain severity (r = 0.248, p <0.01) and pain interference (r = 0.562, p <0.001), but negatively with the physical (r = -0.199; p <0.05) and mental (r = -0.516; p <0.01) components of quality of life. The physical component of quality of life is positively associated with the quality of life of the mental component (r = 0.200; p <0.001) and negatively with pain severity (r = -0.341; p <0.001) and pain interference (r= 0.413; p <0.001). The mental component is negatively correlated with pain interference (r = -0.445; p <0.001). and finally the severity of pain is positively associated with pain interference (r = 0.533, p <0.001). Conclusions:Stress/anxiety and depression are more prevalent in people with chronic kidney disease. High levels of stress/anxiety and depression are associated with high levels of pain causing an impact on activities of daily living, and consequently lowering levels of quality of life in the physical and mental components. Nurses should develop strategies to improve the mental health of people with chronic kidney disease in order to improve their quality of life.