Psychological Distress in Hemodialysis: Impact of Life Events, Illness Perception, and Difficulty Processing Emotions (Alexithymia).

Abstract

Background: Depression and anxiety in individuals undergoing hemodialysis (HD) significantly impair daily functioning and hinder renal rehabilitation efforts. Various factors, including negative life events, illness perceptions, and difficulty processing emotions (alexithymia), have been associated with these psychological challenges; however, their specific impact on HD-related psychological distress remains unclear.

Methods: In this cross-sectional study, 246 individuals receiving HD were assessed using self-administered questionnaires, including the Life Events Scale (LES), Illness Perceptions Questionnaire (IPQ-R), Toronto Alexithymia Scale (TAS-20), and the Hospital Anxiety and Depression Scale (HADS).

Results: The study found that 32.5% and 41.5% of HD patients exhibited symptoms of depression and anxiety, respectively. Logistic regression analyses revealed significant correlations between negative life events, illness perceptions, and alexithymia with both depression and anxiety. Specifically, higher scores on the "Negative Emotional Representation about Illness" subscale were associated with an increased risk of depression (adjusted odds ratio [OR], 1.302; 95% confidence interval [CI], 1.118-1.544; p < 0.001). Conversely, lower scores on "Personal Control" were linked to a heightened risk of depression (adjusted OR, 0.796; 95% CI, 0.683-0.927; p = 0.003). For anxiety, elevated scores in "Negative Emotional Representation about Illness" (adjusted OR, 1.185; 95% CI, 1.014-1.261; p = 0.015) and "difficulty identifying feelings" (adjusted OR, 1.210; 95% CI, 1.031-1.411; p = 0.016) indicated increased risk, while lower scores in "Personal Control" were similarly associated with heightened anxiety risk (adjusted OR, 0.852; 95% CI, 0.734-0.983; p = 0.042).

Conclusion: This study suggests that negative life events, specific illness perceptions, and alexithymia are significant predictors of depression and anxiety among HD patients. Addressing maladaptive illness perceptions and emotional regulation deficits could offer novel strategies to enhance mental health outcomes in this population, highlighting the need for further investigation.