Effects of illness perception on anxiety and depressive symptoms in hemodialysis patients: A multi-center study

Objective: The aims of this study were to assess anxiety and depression risk in hemodialysis patients with end-stage renal failure, and to compare illness perception between patients with or without anxiety and depression risk, using Leventhal's model. Methods: This cross-sectional study was conducted on 124 patients of three major university hospitals. Subjects were 18 years or older, undergoing treatment in a hemodialysis unit for at least 6 months, literate and could communicate in the Turkish language. Patients who were mentally retarded or had psychiatric conditions i. e. psychotic disorders were excluded from the study. Voluntary informed consent was sought from all subjects. Data were collected with a semi-structured questionnaire, Hospital Anxiety and Depression Scale and Illness Perception Questionnaire-Revised (IPQ-R). Illness perception was grounded on Leventhal's self-regulation model. Data were analyzed using frequency distributions, Student's t-test, ANOVA, Pearson correlation and chi-square tests. Results: The mean age of patients was 50.7 +/- 14.5 (18-80) years, 55.6% were male, 33.9% were literate and 69.4% were married. Our results showed that 22.6% of the subjects who underwent hemodialysis for an average of seven years were at risk for anxiety and 49.2% for depression. Patients with anxiety risk had lower IPQ-R dimensional scores in illness coherence and higher scores in emotional representtation, whereas those with depression risk had lower scores in personal control but higher scores in timeline (cyclical) and emotional representation. Conclusion: Hemodialysis patients are at high risk of anxiety and/or depression and this is valid for almost half of the current study sample. Our results show that patients with high risk of anxiety or depression had negative perception of illness. As the self-regulation model is based on a parallel processing of cognitive and emotional representations of illness, further studies in longitudinal design are recommended to better assess the effect of negative illness perceptions on anxiety/depression in hemodialysis patients.