Somatic symptoms and emotional distress in patients on hemodialysis

Objectives: To establish the frequency and severity of somatic symptoms and emotional distress (anxiety and/or depression) among our chronic hemodialy sis (CHD) patients and to study the relationship between them as well as th eir influence on the perceived health status. Patients and methods: All patients who had been on CHD for a minimum of thr ee months were eligible for the study. Eight of them were excluded: six bec ause they were unable to answer the questionnaires and two because they ref used to participate. The 58 remaining patients were the subject of our stud y (median age 68.5 years; median duration of HD 29.5 months). Diverse socio demographic and clinical data were recorded. The patients answered the foll owing questionnaires: I) The physical symptoms,, dimension of the Kidney Di sease Questionnaire; 2) A measure of anxiety (STAI); 3) A measure of depres sion (Beck Depression Inventory and Cognitive Depression Index); and 4) The Nottingham Health Profile (NHP). Results: The most frequent and severe symptoms were tiredness, itching, thi rst, bone and joint pain and sleep disturbance. The severity of the symptom s was positively associated with female sex, and the presence of clinically relevant degrees of anxiety and/or depression. A quarter of the patients w ere anxious and almost half of them suffered from depression. Emotional dis turbances were associated with the severity of somatic symptoms and comorbi dity. Only anxiety and depression were significantly associated with the gl obal NHP score; they explained 47% of its variance. A score of 50 or more i n the "Emotional Reactions" dimensions with the NHP detected 69% of the pat ients with anxiety and 81% of those with depression. Conclusions: Somatic symptoms are common among patients on CHD and they app ear to be associated with emotional distress (anxiety and depression) that influences significantly the perceived health status. Measuring the perceiv ed health status by means of generic and specific questionnaires, may help to establish the diagnosis of these problems.