Sintomas de ansiedade e depressão em pacientes com Doença Renal crônica em tratamento Dialítico.

Abstract

Introduction: Chronic Kidney Disease (CKD) generates numerous negative repercussions on the biopsychosocial aspects of its patients. And dialysis intensifies this impact, increasing the rates of emotional disorders. Objectives: To measure levels of anxiety and depression symptoms in individuals with CKD; to compare whether there is a statistical difference in anxiety and depression scores among patients with CKD in relation to a normative group and to identify which social, demographic and clinical determinants are associated with symptoms of anxiety and depression in individuals with CKD and in relation to one normative group. Method: A cross-sectional, analytical and descriptive study with a quantitative approach and approved by the local ethics committee. Performed in a public institution and a private hemodialysis clinic, in a municipality in the interior of Minas Gerais. There were two categories of participants, one study group (patients with CKD on hemodialysis) and one normative group (general population). Once the psychic and mental fitness were obtained, the evaluation instruments were applied: Demographic and clinical characterization questionnaire and the validated version for use in Brazil of the Hospital Anxiety and Depression Scale (HADS). Data were presented as absolute frequency, relative or as mean, median, standard error, minimum and maximum. In order to compare the profile of the two groups, some variables were dichotomized and then compared with the Independence Chi-Square test with continuity correction and the Mann-Whitney test. To evaluate the influence of social, demographic and clinical variables on the domains of the construct anxiety and depression, we used multiple logistic regression. For this, we used the method of selection of backward variables, based on the criterion of exclusion of the model (considering the probability of Wald test less than 10%). Then, we calculate the Odds Ratio, considering a 95% confidence interval. The evaluation models were used only to describe the studied population in a multivariate perspective. For all analyzes, we adopted a significance level of 0.05. Results: In the study group, there was a predominance of men (59%), incomplete high school education level (68%) and 55% said they did not have a married partner. The majority (53%) were from a private institution and 57% reported having some kind of complication. The variables age, marital status and schooling were different between groups (p <0.05). 32% of the participants in the study group had depressive symptoms, whereas in the normative group it was 17% (p <0.021). The scores of anxiety symptoms in the CKD group were similar to those in the normative population (p = 0.709). As for the depressive symptoms, the mean score of the CKD group (mean = 6.59, SD = 0.42, median = 6) was significantly higher than that of the normative population (mean = 4.96, SD = 31, median = 4.5) (p <0.05). In the evaluation of the influence of variables associated with the occurrence of anxiety symptoms in both groups, they were: female (Bi = 2.072, p = 0.015), smoking (Bi = 3.409, p = 0.005) in a public institution (Bi = 2.055, p = 0.02). On the other hand, living in Uberlândia (Bi = 3.048, p = 0.008), had lower schooling (Bi = -1.872, p = 0.033) and (B = 2.209, p = 0.011) were considered as predictors for the occurrence of depressive symptoms. In the only study group, the predictors for the occurrence of anxiety symptoms were: female (Bi = 1.595, p = 0.003, OR = 4.93), smoking (Bi = 1.917, p = 0.006, OR = 6.8) and to perform hemodialysis in the public sector (Bi = 1,233, p = 0.028, OR = 3.43). In relation to the depressive symptoms, the predictors were sex (Bi = 0.797; p = 0.086; OR = 2.22) number of residents in the residence (Bi = -0.296; p = 0.066; OR = 0.74). Conclusion: The anxiety symptoms of patients with CKD were equivalent to those of the normative population and, for depressive symptoms, the mean score of this group was higher than that of the normative population. The predictors for the occurrence of anxiety symptoms in the hemodialysis group were: being female and undergoing hemodialysis in the public sector. And the predictors for the occurrence of depressive symptoms were: sex and number of residents in the residence. The odds ratio of the "number of residents in the residence" exerted a protective factor for the occurrence of depressive symptoms. All these findings should be considered in the clinical evaluation of these patients. Keywords: Anxiety; Depression; Chronic Renal Insufficiency; Dialysis