Assessing the Impact of Socio-Demographic Factors on Depression and Clinical Outcomes Among Hemodialysis Patients in Pakistan. A cross-Sectional Observational Study

Socio-demographic predictors of depression in HD

Abstract

Background: Depression is markedly more common in people receiving maintenance haemodialysis than in the general population. Clarifying how socio-demographic and clinical factors modulate its severity is essential for effective psychosocial care.

Objectives: To measure the prevalence of depressive symptoms in a Pakistani haemodialysis cohort and to identify independent socio-demographic and treatment-related predictors of clinically significant depression.

Methods: A descriptive cross-sectional study was conducted at the Dialysis Centre of Ghurki Trust Teaching Hospital, Lahore, from May 2023 to December 2024. Using systematic random sampling, 80 adults (40 men, 40 women) aged 25–65 years who had received thrice-weekly haemodialysis for ≥ 3 months were enrolled. A structured interview captured socio-demographics and clinical data; depressive symptoms were assessed with the Urdu-validated Patient Health Questionnaire-9 (PHQ-9; Cronbach’s α = 0.82). Bivariate analyses (χ², Fisher, t- and Mann–Whitney tests) explored associations between PHQ-9 ≥ 10 and candidate predictors; variables with p < 0.20 entered a multivariable logistic-regression model.

Results: The mean PHQ-9 score was 9.1 ± 5.4; 34/80 patients (42.5 %) had clinically significant depression. Women reported higher rates of anxiety (71 % vs 69 %) and sadness (72 % vs 68 %) and were socio-economically disadvantaged (employment 20 % vs 38 %; median income 28 000 vs 35 000 PKR). Men had longer dialysis vintage (4.6 ± 2.0 vs 4.2 ± 2.0 years), while women had a higher BMI (27.4 ± 4.5 vs 25.6 ± 3.7 kg m⁻²; p = 0.046). The final logistic model (Hosmer–Lemeshow χ² = 5.77, p = 0.67; Nagelkerke R² = 0.34) identified three independent predictors: female sex (adjusted odds ratio [AOR] = 2.08, 95 % CI 1.04–4.18, p = 0.038), unemployment (AOR = 3.36, 1.38–8.20, p = 0.008) and longer dialysis vintage (AOR = 1.04 per month, 1.01–1.06, p = 0.006). Low income lost significance after employment entered the model, suggesting mediation by joblessness.

Conclusion: Depression in Pakistani haemodialysis patients is driven chiefly by social determinants—female gender, unemployment—and by the cumulative psychological burden of prolonged dialysis, rather than by routine biochemical parameters. Integrating gender-sensitive mental-health screening and vocational-support services into dialysis programmes could mitigate this burden. Larger, longitudinal studies are warranted to refine causal pathways and evaluate targeted interventions.