[Physical Symptoms and Emotional Disorders in Patient on a Periodic Hemodialysis Program]

Objectives: To establish the frequency and severity of somatic symptoms and emotional distress (anxiety and/or depression) among our chronic hemodialysis (CHD) patients and to study the relationship between them as well as their influence on the perceived health status.

Patients And Methods: All patients who had been on CHD for a minimum of three months were eligible for the study. Eight of them were excluded: six because they were unable to answer the questionnaires and two because they refused to participate. The 58 remaining patients were the subject of our study (median age 68.5 years; median duration of HD 29.5 months). Diverse sociodemographic and clinical data were recorded. The patients answered the following questionnaires: 1) The "physical symptoms" dimension of the Kidney Disease Questionnaire; 2) A measure of anxiety (STAI); 3) A measure of depression (Beck Depression Inventory and Cognitive Depression Index); and 4) The Nottingham Health Profile (NHP).

Results: The most frequent and severe symptoms were tiredness, itching, thirst, bone and joint pain and sleep disturbance. The severity of the symptoms was positively associated with female sex, and the presence of clinically relevant degrees of anxiety and/or depression. A quarter of the patients were anxious and almost half of them suffered from depression. Emotional disturbances were associated with the severity of somatic symptoms and comorbidity. Only anxiety and depression were significantly associated with the global NHP score; they explained 47% of its variance. A score of 50 or more in the "Emotional Reactions" dimensions with the NHP detected 69% of the patients with anxiety and 81% of those with depression.

Conclusions: Somatic symptoms are common among patients on CHD and they appear to be associated with emotional distress (anxiety and depression) that influences significantly the perceived health status. Measuring the perceived health status by means of generic and specific questionnaires, may help to establish the diagnosis of these problems.