Depression and Marital Discontent among Hemodyalsis Patients and their Spouses in Pakistan
DOI:
https://doi.org/10.21649/akemu.v31iSpl2.5730Keywords:
Depression, Marital Discontent, MHD, RDASAbstract
Background: Marital dyad is an interdependent unit, wherein the depression and marital discontent experienced by the patient on maintenance hemodialysis (MHD) influences the non-patient spouse.
Objective: To determine the severity of depression and level of marital discontent among patients on MHD and their spouses and the effect of depression on marital adjustment.
Methods: This cross sectional study was conducted at Nephrology Department, Mayo Hospital, Lahore from October 2023 to March 2024. Ninety-Four married couples in whom one partner was on MHD for ≥3 months were included in the study. The degree of depression was assessed using Beck Depression Inventory (BDI) whereas marital adjustment was determined using Revised Dyadic Adjustment Scale(RDAS).
Results: Of the 94 couples, 60% patients and 42.5% spouses reported mild to moderate or severe depression, with poor marital adjustment present in 47.8% patients and 44.6% of the spouses. Patient’s depression correlated with spousal depression(r=0.655, p<0.01) and RDAS scores of both the patient and their spouse(r=-0.628, p<0.01). In addition, spouse’s depression correlated negatively with their own RDAS score. Couples in joint families had lower levels of depression and marital adjustment, as indicated by higher RDAS score.
Conclusion: In this study, degree of depression in patient on MHD showed a strong correlation with depression in non-patient spouse. Severe depression in patients resulted in poor marital adjustment for both the patients and their spouses. Marital discontent and depression in both the patient and spouse were affected negatively by poor socioeconomic conditions and positively by social support in the form of joint family system.
References
1. Chilcot J, Pearce CJ, Hall N, Rehman Z, Norton S, Griffiths S et al. Depression and anxiety in people with kidney disease: understanding symptom variability, patient experience and preferences for mental health support. J Nephrol. 2025;38(2):675-86. doi:10.1007/s40620-024-02194-1.
2. Adejumo OA, Adejumo OA, Edeki IR, Sunday Oyedepo D, Falade J, Yisau OE et al. Global prevalence of depression in chronic kidney disease: a systematic review and meta-analysis. J Nephrol. 2024;37(9):2455-72. doi:10.1007/s40620-024-01998-5.
3. Haider AS, Unbrin A, Shahzadi M. Prevalence of Depression, Anxiety, Stress, and Quality of Life among Individuals with Hemodialysis: Hemodialysis and Quality of Life. Pak J Health Sci. 2024;5(08):253-8. doi.org/10.54393/pjhs.v5i08.1856.
4. Khaira A, Mahajan S, Khatri P, Bhowmik D, Gupta S, Agarwal SK. Depression and marital dissatisfaction among Indian hemodialysis patients and their spouses: a cross-sectional Study. Ren Fail. 2012;34(3):316-22. doi:10.3109/0886022X.2011.647291.
5. Sharma R, Sharma SC, Chalise P, Regmee J, Sharma S. Anxiety and Depression among Patients with Chronic Kidney Disease Undergoing Haemodialysis in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2022;60(251):634-7. doi:10.31729/jnma.7608.
6. Tayebi A, Einollahi B, Rahimi A, Sirati-Nir M. The non-adherence with treatment in dialysis patients in Iran, a systematic review. Iran. J. Kidney Dis. 2019;13(6):347-61. PMID:31880581.
7. Kimmel PL, Peterson RA, Weihs KL, Shidler N, Simmens SJ, Alleyne S et al. Dyadic relationship conflict, gender, and mortality in urban hemodialysis patients. J Am Soc Nephrol. 2000;11(8):1518-1525. doi:10.1681/ASN.V1181518.
8. Daneker B, Kimmel PL, Ranich T, Peterson RA. Depression and marital dissatisfaction in patients with end-stage renal disease and in their spouses. Am J Kidney Dis. 2001;38(4):839-46. doi:10.1053/ajkd.2001.27704.
9. Channa R, Suhail MA, Kumar N, Kaleem M, Ali K, Khan HS. Depression in End Stage Renal Disease Patients on Maintenance Hemodialysis at Liaquat University Hospital Hyderabad / Jamshoro. Ann Pak Med Coll. 2021;15(1):60-3. doi:10.29054/apmc/2021.741.
10. Iqbal MS, Iqbal Q, Iqbal S, Ashraf S. Hemodialysis as long-term treatment: Patients' satisfaction and its impact on quality of life. Pak J Med Sci Q. 2021;37(2):398. doi:10.12669/pjms.37.2.2747.
11. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71. doi:10.1001/archpsyc.1961.01710120031004.
12. Crane DR, Middleton KC, Bean RA. Establishing criterion scores for the Kansas Marital Satisfaction Scale and the Revised Dyadic Adjustment Scale. Am J Fam Ther. 2000;28(1):53–60. doi: 10.1080/019261800261815.
13. Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: a prospective follow-up study. BMC Public Health. 2019;19(1):531. doi:10.1186/s12889-019-6796-z.
14. Kamel R, Fouad M, Goda T. Anxiety and depression among hemodialysis patients in Egypt. Zagazig Univ Med J. 2022;28(3):594-604. doi:10.21608/zumj.2021.98028.2361
15. Min J, Yorgason JB, Fast J, Chudyk A. The impact of spouse’s illness on depressive symptoms: The roles of spousal caregiving and marital satisfaction. J Gerontol B Psychol Sci Soc Sci. 2020;75(7):1548-1557. doi:10.1093/geronb/gbz017.
16. Sousa H, Ribeiro O, Figueiredo D. End‐stage renal disease is not yours, is not mine, is OURS: Exploring couples lived experiences through dyadic interviews. Hemodial Int. 2021;25(3):361–71. doi:10.1111/hdi.12929. PMID: 33763973.
17. Weitkamp K, Feger F, Landolt SA, Roth M, Bodenmann G. Dyadic Coping in Couples Facing Chronic Physical Illness: A Systematic Review. Front Psychol. 2021;12:722740. doi: 10.3389/fpsyg.2021.722740
18. Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between financial hardship and symptom burden in patients receiving maintenance dialysis: A systematic review. Int J Environ Res Public Health. 2021;18(18):9541. doi:10.3390/ijerph18189541
19. Implementation of revised minimum wage in Punjab region [Internet]. Fair Labor Association. 2023 [cited 2024 Mar 17]. Available from: https://www.fairlabor.org/resource/ib-pakistan/
20. Islam G, Shah GH, Saeed N, Jones JA, Karibayeva I. A Cross-Sectional Multivariable Analysis of the Quality of Hemodialysis Patients' Life in Lahore City, Pakistan. Healthcare (Basel). 2025;13(2):186. doi:10.3390/healthcare13020186.
21. Du W, Luo M, Zhou Z. A study on the relationship between marital socioeconomic status, marital satisfaction, and depression: Analysis based on actor–partner interdependence model (APIM). Appl Res Qual Life. 2021;17(3):1477–99. doi:10.1007/s11482-021-09975-x
22. Saqib Lodhi F, Ahmed Khan A, Raza O, Uz Zaman T, Farooq U, Holakouie-Naieni K. Level of satisfaction and its predictors among joint and nuclear family systems in District Abbottabad, Pakistan. Med J Islam Repub Iran. 2019;33:59. doi:10.34171/mjiri.33.59.
23. Pawar N, Kumar N, Vikram A, Sembiah S, Rajawat G. Depression and its socio-demographic correlates among urban slum dwellers of North India: A cross-sectional study. J Family Med Prim Care. 2022;11(6):2369-76. doi:10.4103/jfmpc.jfmpc_616_21.
24. Sabre K. Marital adjustment among women: A comparative study of nuclear and joint families. Int J Ind Psychol. 2016;3(2). doi:10.25215/0302.077
25. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4)117-314.PMID: 38490803
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