Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of Congo
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The International Journal of Indian Psychology
ISSN 2348-5396 (Online) | ISSN: 2349-3429 (Print)
Volume 8, Issue 4, Oct- Dec, 2020
DIP: 18.01.124/20200804, DOI: 10.25215/0804.124
http://www.ijip.in
Research Paper
Anxiety, depression and quality of life among adult patients in
Kinshasa, Democratic Republic of Congo
Kibokela Ndembe Dalida1, Longo Mbenza Benjamin 1, 2, 3, Tukadila Kabangi
Hervé Alex2, Banzulu Bomba Degani1, Mvitu Muaka Moïse1,2, Mifundu
Milongo Abraham1, Nkodila Natuhoyila Aliocha2*,
Mampunza Ma Miezi Samuel1
ABSTRACT
Aim: To assess the level of anxiety, depression and quality of life of patients with chronic
hemodialysis. Methods: This cross-sectional study was carried out from 1 September 2017 to
31 January 2018 in three hemodialysis centers in the City Province of Kinshasa in 100
patients. The study assessed anxiety and depression using the Hospital anxiety and
depression scale (HADS) and quality of life using the Kidney Disease Quality of Life
(KDQoL) scale. Results: The average age was 51-13.8 years with a sex ratio of 2.1. 28% of
subjects were anxious, 41% depressed and 50% had an impaired quality of life. Diabetes
mellitus was associated with depression, while age-60, male, high level of education, and 12-
month duration of hemodialysis were associated with impaired quality of life. Conclusion:
Chronic hemodialysis has anxiety, depression and impaired quality of life requiring
multidisciplinary management.
Keywords: Anxiety, Depression, Quality of life, Chronic hemodialysis, Kinshasa
A
ccording to the World Health Organization (WHO), chronic non-communicable
diseases are currently responsible for 60% of the total burden of disease. They are
growing at such a rate that by 2020, low- and middle-income countries, including
the Democratic Republic of Congo (DRC), will see their burden of disease accounted for at
80% of chronic diseases [1]. These countries are undergoing a real epidemiological
transition, seeing non-communicable diseases gradually gaining the upper hand over
infectious diseases [2]. WHO predicts a 17% increase in the prevalence of chronic kidney
disease over the next 10 years [3]. It is now estimated that 850 million people worldwide
suffer from chronic kidney failure (CKF), more than double the number just four years ago
(353 million in 2015). The ESCKF death rate (at least 2.4 million per year in 2015 and 5 to
1
Department of Neuropsychiatry, University of Kinshasa, Kinshasa, DRC
2
Faculty of Public Health, Lomo University of Research, Kinshasa, DRC
3
Walter Sisulu University, Faculty of Health Sciences, Mthatha, South Africa
*Responding Author
Received: November 10, 2020; Revision Received: December 14, 2020; Accepted: December 31, 2020
© 2020, Dalida K.N, Samuel M.M.M, Benjamin L.M, Alex T.K.H., Degani B.B, Moïse M.M, Abraham M.M &
Aliocha N.N.; licensee IJIP. This is an Open Access Research distributed under the terms of the Creative
Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any Medium, provided the original work is properly cited.Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
10 million per year in 2018) is among the fastest growing death rates [4-5]. In Canada, the
number of people with end-stage kidney failure has increased by 35% since 2008, with an
estimated four million Canadians affected by kidney disease of various origins [4]. In the
same vein, it should be noted that in France, the incidence of end-stage chronic kidney
failure (ESCKF) was 165 per million inhabitants in 2016 [6]. In low- and middle-income
countries, particularly in Sub-Saharan Africa, IRC-related mortality is reported to be high
due to insufficient material, financial and human resources [7-8]. Hemodialysis remains the
ultimate treatment of patients with terminal CKD. In France, more than 8 out of 10 patients
(85.2%) had the first treatment for hemodialysis in the center, while pre-emptive
transplantation was 4.7% of patients, according to the 2017 Kidney report. The heavy socio-
economic and emotional burden that accompanies end-stage chronic kidney failure and its
therapeutic corollary, which is hemodialysis, tests the coping abilities of any patient [10].
Depression is one of the mental pathologies that is associated with chronic diseases such as
CKD. It is accepted that in the general population, depressive syndrome affects 15% of
individuals (more than 300 million people) and generalized anxiety affects 0.4 to 3.6% of
people [11], while in the dialysis population, studies have shown a high prevalence of
depressive syndrome, ranging from 20 to 69% [10, 12-6]; anxiety syndrome between 25 and
56% of hemodialysis [15, 17-9] and an alteration in quality of life in nearly 65-90% of
hemodialysis [20-2]. According to Dominique Cupa, there is a more or less severe
depression in every dialysis-free. And even according to Becker quoted by D. Cupa, dialysis
is a chronic depressive [23-4]. Anxiety and depression affect the quality of life of chronic
hemodialysis and hinder their ability to accept and adapt to this ongoing medical care [25].
Chronic kidney disease (CKD) is a global public health problem due to the increasing
incidence and prevalence rates due to the increase in its main risk factors, namely diabetes
high blood pressure, other cardiovascular diseases, collagens and an aging population, as
well as the consequences and high cost of end-stage management, frequently limiting access
in many adequate follow-up or extra-renal replacement treatment [2, 26-7].
In the face of increasing prevalence of chronic diseases, WHO has made improving the
quality of life of people with chronic diseases a priority [28]. Indeed, the patient's quality of
life is an important objective of therapeutic management that should enable these patients to
have a life close to normal, both in duration and quality [29]. The prevalence of ESCKF
varies from country to country and access to treatment depends on the socio-economic level
of the country concerned [30].
The 2030 projections predict that more than 70% of the world's population with end-stage
chronic kidney disease will end up in low- and middle-income countries, including most
sub-Saharan African countries [31-2]. Treatment of ESCKF with hemodialysis is
accompanied by a high mortality rate, psychological impact and very high cost, especially in
a resource-constrained environment. The ESCKF is therefore a heavy socio-economic
burden [26].
In our country, the Democratic Republic of Congo (DRC), little data on the epidemiology of
ESCKF exists, given the absence of a national registry in nephrology. Despite the absence of
epidemiological data on the direct and indirect incidence and costs of the Chronic kidney
disease, analysis of data recorded at the University Clinics of Kinshasa (CUK) showed a
gradual and worrying annual increase in (60.6%, 65.9%, 67.4% and 70.5%) admitted to
CUK, almost exclusively in the terminal stage of the disease requiring rapid management by
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1054Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
dialysis and that in the absence of dialysis, there is a high mortality associated with
cardiovascular complications and uremia [33-4].
The increase in this prevalence of ESCKF raises fears of an increase in its psychological
impact (mostly anxiety and depression) thus increasing management and thereby altering
quality of life [12, 35]. Hemodialysis has transformed the once fatal evolutionary course of
the ESCKF and has significantly changed the way patients are managed, thereby improving
patient comfort and life expectancy [26]. However, as a palliative treatment, dialysis
abruptly confronts the patient with the idea of death, his life based only on heavy and
restrictive treatment that offers him only artificial survival [36].
In general, subjects with associated depressive conditions experience a more severe
evolution of their somatic pathology, with an increased risk of death on the one hand and on
the other hand, the evolution of this associated depressive pathology is sometimes
aggravated by the existence of certain organic diseases [37]. For patients with chronic
hemodialysis, the severity of depressive symptoms is associated with higher mortality [38].
Indeed, the patient is confronted with the brutal and difficult to accept, the aggressions,
which suffer his body and his personal, family and socio-professional life. These
disturbances are at the root of difficulties in coping and psychological distress [10].
These hemodialysis-induced psychological and social upheavals are too often overlooked,
due to selective focus on kidney disease and/or diagnostic difficulty associated with
entanglement of various disorders. However, these psychosocial factors are major
determinants in improving the quality and life expectancy of hemodialysis [39].
In Kinshasa, patients treated with hemodialysis receive little structured psychological
support and to date few studies have focused on assessing the extent of anxiety and
depressive disorders and quality of life in patient’s hemodialysis and the factors associated
with them. The chronicity, the entanglement of somatic and psychological aspects in the
evolution of End-stage chronic kidney failure (ESCKF), and the heaviness of hemodialysis
therapy and their impact on quality of life justifies this study. Therefore, the objective of this
study was to assess the prevalence rates and the determinants of anxiety, depression and
quality of life related to chronic hemodialysis patients from Kinshasa Megacity, in DRC.
MATERIALS AND METHODS
This study was carried out in three hemodialysis centers in the City province of Kinshasa.
These are the Hemodialysis Centers of the Kinshasa Provincial Reference General Hospital
(HGPRK), Afia Medical Care Clinic Mont des Arts and Ngaliema Medical Center.
This cross-sectional, descriptive and analytical study was carried out from 1 September 2017
to 31 January 2018. A fact sheet (annex) with pre-coded closed questions had been
developed. It consisted of questions on socio-demographic, clinical and hemodialysis data.
HADS (Hospital Anxiety and Depression Scale)
The Scale of Anxiety and Depression (HADS) is a self-question widely used in international
literature. Easy and quick to use, it can assess anxiety and depressive symptomatology in
people with somatic diseases. She has the notable advantage of not being sensitive to the
symptoms associated with a physical disorder [60]. HADS is a simple and validated
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1055Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
evaluation scale in Africa for use by non-mental health specialists [76]. The combination of
somatic pathology and an anxiety-depressive disorder is not uncommon [57].
It is well established that there is interference between symptoms related to CESRD and
somatic symptoms of depression or anxiety [59]. This is how we chose to use HADS to
screen for both anxiety and depression. The HADS has 14 items rated from 0 to 3 on a
Likert scale. Seven questions relate to anxiety (total A) and seven questions to the
depressive dimension (total D), thus achieving two scores (maximum score of each score -
21).
KDQoL (Kidney Diseases Quality of Life)
The Kidney Diseases Quality of Life (KDQoL) is a self-question specific to kidney failure
patients treated with dialysis that was built by Hays et al. It consists of a generic part, SF-
36, and a part specific to dialysis [78]. The generic part, MOS-SF 36 (Medical Outcome
Study, Short-Form 36) consists of 36 items grouped into 8 dimensions that can themselves
be summarized into two main components: physical (physical functioning, limitations due to
the condition physical pain and general health) and mental health (mental health, mental
limitations, life and relationships with others, vitality).
The specific part of dialysis, this module is composed of 43 items that are grouped into 11
dimensions: symptoms and health problems, effects of kidney disease, burden of kidney
disease, occupational status, cognitive function, quality of environment, quality of sexual
activity, sleep, friendly and family relationships, encouragement received from the dialysis
team and satisfaction with care [35, 68]. KDQoL is the most widely used specific
measurement instrument in dialysis research [35, 79].
KDQoL scores have been standardized in such a way that 0 corresponds to the worst quality
of life and 100 to the best quality of life. The threshold is 66.7 below which a quality of life
is said to be impaired [22, 78]. The 19 dimensions were grouped into 6 dimensions
(physical component, mental component, weight or burden of disease, symptoms or
problems of kidney disease, consequences or effects of kidney disease, and satisfaction with
care).
Data collection procedure
All data from this study were collected by the lead instigator of the study. Once the
authorization of the hemodialysis managers was obtained, explanation sessions of the
research protocol were conducted with the patients in order to obtain their informed consent.
Ethical considerations
To participate in this study, patients agreed by written consent. They benefited from in-depth
and informed explanations of the study's objectives, the evaluation procedure and their
safety. Confidentiality was guaranteed to them. At any point in the study the patient could
interrupt his participation in the research for personal reasons. The survey received a
favourable opinion from the National Health Ethics Committee, under number
107/CNES/BN/PMMF/2018.
Operational Definitions
The CKD is defined by the presence, for more than 3 months, markers of kidney damage
that may be morphological abnormalities (on ultrasound or other examinations), histological
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1056Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
abnormalities (on a renal biopsy), biological abnormalities (proteinuria, albuminuria,
hematuria, leukoocyturia, or decreased glomerular filtration rateAnxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
forms of anxiety are human. Anxiety, however, can become a disease that combines
different symptoms (psychological, behavioural, somatic) and causes significant suffering
and discomfort in daily life. This is referred to as anxiety disorders.[57]
Psychological manifestations can result in apprehension, anxiety, rumination, irritability,
tension, difficulty paying attention and/or concentration, memory lapses etc. Behavioural
signs may occur in the form of avoidance, clumsiness, hyperactivity, agitation or feeling of
being over-excited or exhausted, compulsions, rituals, addictive behaviours, etc. Somatic
changes can be manifested by chest or muscle pain, digestive problems, sweating, sleep
disturbance, or fatigue, etc. [54].
Depression
Depression is a mood disorder characterized by a sad mood or loss of interest or generalized
pleasure, occurring almost daily for at least two weeks. Symptoms prevent the person from
carrying out his or her daily activities [55]. It can also be defined by feelings of sadness,
helplessness, despair and inadequacy [54].
Depression is the result of a complex interaction between biological, psychological and
social factors [56]. People exposed to unfortunate events in their lives (chronic illness,
unemployment, bereavement, psychological trauma and others) are more likely to develop
depression. This, in turn, can lead to increased stress and dysfunction and worsen the
situation of the affected person, as well as depression itself. There is an interdependence
between depression and physical health. For example, cardiovascular disease can lead to
depression and vice versa [11].
Statistical analyzes
1. After the evaluation coupled with the data validation, the data was entered on a
computer using the 2010 MS Excel software and analyzed using SPSS version 25.0
software.
2. The description of clinical, socio-demographic and hemodialysis data was conducted
using frequencies for qualitative variables and standard deviation averages for
quantitative variables.
3. The association on the one hand between the different sociodemographic, clinical
and hemodialysis parameters, and on the other hand, quality of life, anxiety and
depression was evaluated by bivariate analyses. The Chi square test and the t-test
were used to investigate the association between dichotomous variables.
4. Results with PAnxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
sessions per week (32%), for a duration of 12 months in 54% of cases, these sessions were
only 37% secure (Table 2).
Table 2. Breakdown of subjects according to their socio-demographic and clinical
characteristics
Variables Effective (n=100) Percentage
Age (years)
< 60 70 70.0
>60 30 30.0
Sex
Male 68 68.0
Female 32 32.0
Civil status
Single 19 19.0
Married 71 71.0
Divorced 11 11.0
Widower 9 9.0
Education Level
Secondary 29 29.0
Superior and Academic 71 71.0
Profession
Without Employment 29 29.0
Employee 71 71.0
Religion
Traditional 53 53.0
Non-traditional 47 47.0
HTA 73 73.0
Other Cardiovascular Diseases 12 12.0
Diabetes Mellitus 37 37.0
Drop 6 6.0
Infectious disease 2 2.0
Consumption of psychoactive substances 17 17.0
Anxiety 28 (28.0) 41 (41.0)
Depression 50 (50.0) 72 (72.0)
Impaired Quality of Life 59 (59.0) 50 (50.0)
Variables Mean (SD)
Anxiety 5.90 - 3.28
Depression 7.17 -3.63
Quality of Life
Overall Score 6 5.07±6.60
Physical Component Score 59.72 ± 14.00
Mental Component Score 46.40±12.19
Disease Weight Score 65.88 ± 10.62
Score Symptoms of Kidney Disease 71.09 ± 12.27
Score Consequences of Kidney Disease 66.20±13.31
Care Satisfaction Score 81.15±15.87
Duration of dialysis (months)
≤12 months 54 54.0
>12 months 46 46.0
Number of session/week
sessions 68 68.0
sessions 32 32.0
Funding dialysis
Unsecured 63 63.0
Secured 37 37.0
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1059Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
This table shows that the male sex (p = 0.032), the age ≥60 years (p = 0.029), the higher
level of study (p = 0.015) and the duration of hemodialysis ≤12 months (p = 0.016) are
associated with an impaired quality of life. It is clear from this table above that no socio-
demographic factors, clinical or hemodialysis was not significantly associated with anxiety
(Table 3).
Table 3. Socio-demographic factors, Clinical and Hemodialysis Associated with Anxiety
Variable Anxiety Presence Absence of Anxiety p
n=28 n=72
Sex 0.147
Male 16 (57.1) 52 (72.2)
Female 12 (42.9) 20 (27.8)
Age (years) 0.496
12 17 (34.0) 29 (58.0)
Session number/week 0.779
1 8 (16.0) 7 (14.0)
2à3 42 (84.0) 43 (86.0)
Average score of the subjects who are anxious in the mental health component (t =5.016, p <
0.001) is statistically higher than that of non-anxious subjects. The average score of anxious
subjects with the symptoms dimensions of RD (t =3.175, p = 0.002) and consequence of RD
(t = 2.797, p = 0.006) is statistically lower than that of non-anxious subjects (Table 4).
Table 4. Average quality of life scores of subjects relative to anxiety
Score to components of KDQoL Anxiety Absence Anxiety t p
Mean ±SD Mean ±SD
Physical component 60.742 ± 14.42 57.10 ± 12.74 1.174 0.243
Mental Component 55.19 ± 9.38 42.99 ± 11.46 -5.016 0.000
Weight represented by RD 68.09 ± 10.27 65.02 ± 10.70 -1.301 0.196
Symptoms of the RD 65.11 ± 12.29 73.41 ± 11.53 3.175 0.002
Consequence of the RD 60.42 ± 11.38 68.44 ± 13.40 2.797 0.006
Satisfaction of Care 76.70 ± 18.03 82.88 ± 14.71 1.768 0.080
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1060Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
Average score of depressed subjects in the mental health component (t =2,539, p =0.013) is
statistically higher than that of non-depressed subjects. The average score of depressed
subjects in the physical health component (t = 2.010, p = 0.047) and the dimension
symptoms of kidney disease (t = 2.740, p = 0.007) is statistically lower than that of non-
depressed subjects (Table5).
Table 5. Average Quality of Life Scores of Subjects relative to Depression
Score at components of Depression Absence Depression t p
KDQoL Mean ±SD Mean ±SD
Physical Component 56.39 ± 14.60 62.03 ± 13.21 2.010 0.047
Mental Component 50.02 ± 11.93 43.89± 11.82 -2.539 0.013
Weight of RD 67.13 ± 11.15 65.01 ± 10.25 -0.984 0.328
Symptoms of THE RD 67.18 ± 12.78 73.80 ± 11.23 2. 2740 0.007
Consequence of RD 63.21 ±14.14 68.27 ± 12.40 1.891 0.062
Satisfaction of Care 81.381 ± 17.28 80.99 ± 14.96 -0.120 0.905
DISCUSSION
This study showed that the hemodialysis population in Kinshasa is on average 51-13.08
years old. This result is similar to that found in sub-Saharan Africa. Indeed, in Benin (2015),
Viga Jacques et al, Togo (2014), Sabi KA et al and Mali (2011), Diallo et al, found an
average age of 49.6 years, 49.5 years and 40.36 years respectively [81-3]. In contrast, in
developed countries such as France, the 2016 report by the Epidiological and Information
network in Nephrology (Kidney) showed that ESCKF affected older subjects more (average
age 70.6 years) [6].
This difference could be linked to the medical advance of developed countries, resulting in
longer life expectancy with pyramids of the wider ages at the top; unlike the youth of the
African population. It is a young and active population, which is a negative socio-economic
factor for production and profitability.
Male predominance was noted in our sample (68%). Our results are consistent with most of
the work done on chronic kidney failure. Indeed, Yi-Nan li et al in China (2016), Sabi KA
et al in Togo (2014) and KOUA AM et al in Côte d'Ivoire (2013), as well as the Quality of
Life Report - Kidney Dialysis Volet 2005 found similar results, i.e. a percentage of 68%
respectively. , 65%, 72, 3% and 60% [36, 82, 84-5]. It should be noted, however, that
different results exist in Africa, in Mali in particular where Coulibaly N et al (2017), found a
slight female predominance (51.6%), as well as in Senegal (2015) where the Ndiaye et al
study found 53% of women [13, 86]. Worldwide, chronic kidney disease is apparently more
common in women than in men, but paradoxically, the number of women starting
replacement therapy is much lower than that of men [87].
No doubt male predominance can be justified by greater exposure of men to risk factors for
the progression of CKD such as tobacco [88].
The bride and groom made up the majority of our sample (71%). This frequency is
comparable to studies conducted by Sabi KA et al in Togo (2014) (74%); AM KOUA et al
in Cote d'Ivoire (2013) (85.3%); Coullibaly et al in Mali (2017) (72%) and Njah M et al in
Tunisia (2001) (70.6%) [10, 36, 82, 86]. No doubt the solidity of the marriage institution,
still well inked in African customs and traditions justifies this observation.
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1061Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
In contrast, in France(2014), Speyer E et al found that only 37.1% of patients lived in a
couple [88]. Indeed, the absence of a spouse promotes the isolation of the patient who will
face additional difficulties alone, aggravating the feeling of worthlessness [20, 22].
Nearly three-quarters of patients (71%) had a higher level of study (University). This result
is a departure from those of Abdelilah et al in Morocco (2017) who found only 7.8% of
patients of higher education [90]. Similarly, Lobna Zouari et al in Tunisia (2016) and
Vasilopoulu C et al in Greece (2016) had found 7% and 26.1% of patients of higher
education respectively [19, 20].
However, our result is consistent with WHO data that the majority of the illiterate and poor
African population is being treated through traditional medicine, and that as a result it is a
minority in environmental studies hospital [91]. In addition, subjects who are educated are
better informed and know where to go for their care [92].
Seventy one percent of patients had a job, in contrast to studies conducted by Ndiaye et al in
Senegal (2015) where only 31.3% of patients were employed. In the same vein as the
Senegalese study, Fouda H. et al in Cameroon (2017) and Abdelilah el Filali et al in
Morocco (2017) found 36% and 14.6% of patients respectively [8, 13, 90].
Our data corroborate with studies conducted by Mawufeno Y et al in Togo (2014) where
90.9% of patients were employed, and by Vigan J. et al in Benin (2015) with 76.3% of
employees [16, 81]. Maintaining a professional activity is considered a protective factor.
Thus, while inactivity is often seen as a source of social demoralization, work would allow
the patient to broaden the scope of his relationships, to ensure his responsibilities, to assert
his independence and thus to control his situation [19]. Kidney failure is not incompatible
with professional activity. In most cases, a hemodialysised person can continue to work, at
least part-time. Dialysis sessions scheduled for the end of the day are often a way to
maintain a professional activity.
In half of cases, chronic kidney diseases that lead to ESCKF are the result of two
pathologies, diabetes mellitus (diabetic nephropathy) or high blood pressure (nephropathy
[26, 44, and 49]. In 2015, diabetic kidney disease was the leading cause of dialysis in
developed countries, with an incidence of 22%. As for hypertensive kidney disease, it
accounted for 25% of new cases of ESCKF. HBP is a major risk factor associated with CKD
and may also be integrated into outbreaks of a KD of other origin [93]. Nearly three-fourth
of the patients was hypertensive. This result is comparable to that of Coulibaly N et al in
Mali (2017) (74.8%) Ndiaye et al in Senegal (2015) (68.9%) [13, 86]. On the other hand, a
lower frequency was found by Yue Hou et al in China (2014) (14.8%), Lobna Aribi and al in
Tunisia (2016) (30%) [18, 94]. Thirty-seven percent of hemodialysis patients had an ATCD
of diabetes mellitus. This is similar to studies by Kyungim Kim et al in South Korea (2018),
Collister David et al in Canada (2018), Florence Glaude et al in France (2016), Yi-Nan Li et
al in China (2016) which found 52% respectively, 48%, 41.6% and 40% [6, 17, 84, 95].
On the other hand, West African studies by Ndiaye et al (2015), Coulibaly N et al (2017)
and Lobna Zouari et al (2016) found lower values of 6.02%, 8.4% and 15.5% respectively
[13, 20, 86]. This difference is probably related to the selection of patients in the different
studies.
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1062Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
The association of somatic pathology and an anxiety-depressive disorder is not uncommon.
It is well established that there is interference between the symptoms associated with the
terminal CKD and the somatic symptoms of depression or anxiety [60, 62]. This is how we
chose to use the HADS scale to screen for both anxiety and depression.
The prevalence of anxiety was 28% and that of depression was 41%. This prevalence of
anxiety is similar to the results of studies conducted by Abdelilah et al (2017) (25.2%),
MAIGA DD et al in Niger (2013) (22.4%), and by Rocha Augusto et al in Belgium (2011)
(24.2%) [15, 90, 96]. On the other hand, a much higher frequency of anxiety was observed
in studies conducted by Collister David et al. (2018), Lobna Aribi et al. (2015) and
Vasilopoulou Chrysoula et al. (2016) with a frequency of 56%, 56% and 47.8% respectively
[17-9].
Data from the literature report a prevalence of 20 to 68% of depression among hemodialysis
[13-6, 25, 60, and 79]. This is comparable to our result, 41%. This variation in frequency is
likely to be related to the use of different tools to assess anxiety and depression. Depression
was significantly associated with diabetes mellitus. The latter is itself a risk factor for
depression regardless of hemodialysis [57, 97].
The overall average score (OAS) was 65.07 -6.60 with an impaired quality of life in 50% of
hemodialysis using the threshold of 66.7 recommended by Lean et al. [98]. Comparing these
results with studies that used the same scale to assess the quality of life of hemodialysis
patients, our results were superior to those of the Nasr et al (2001) studies that achieved an
OAS of 51.4-24.3 with an alteration in quality of life in 65% of patients; Gataa et al (2008)
noted an impaired quality of life in 75.2% of their patients with an OAS of 55.1 - 11.7;
Lobna Zouari et al (2016) found an SMG of 51.6-14.02 with 90% of patients with impaired
quality of life [20-2]. This difference is likely to be related to family support, continued
professional activity, encouragement of the health care team and satisfaction with care.
This study is consistent with literature evidence that quality of life deteriorates with age [19,
86, 99]. This can be explained not only by the deterioration of physical health, by the decline
in general adaptive capacities in the elderly, but also by the decline in social support [17, 21,
100]. Indeed, the experience of decreased performance, body modifications and the
installation of comorbidities leads to a feeling of decline. The elderly person's abilities are
reduced, especially as the side effects of dialysis appear, thus exacerbating his feelings of
helplessness.
Male sex and higher education are associated with impaired quality of life. This result runs
counter to that found by some authors who noted an association with the female sex and low
level of education. According to these authors, the woman would have a more developed
emotional component and a high level of education would protect against the deterioration
of the quality of life of hemodialysis [20-1, 35, 70, 74]. We believe that the weight of
responsibility given to men and intellectuals in Congolese society justifies our findings.
The association between short duration in hemodialysis and impaired quality of life was
found in this study. It is clear that our results are the opposite of those found in most studies.
The longer the time it lasts on dialysis, the more the quality of life of patients is impaired.
This negative association is related to the onset over time of comorbidities and
complications limiting the patient [85, 100-1]. The correlation between quality of life and
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 1063Anxiety, depression and quality of life among adult patients in Kinshasa, Democratic Republic of
Congo
short duration in hemodialysis in our context could be justified by a lack of adaptation to
hemodialysis status, and the lack of information of patients in relation to the disease.
The average score for the mental health component of anxious and depressed subjects was
statistically higher than that of non-anxious and non-depressed subjects, while the opposite
would be expected. This can be explained by the fact that there are discrepancies in the
content of the mental or psychic domain. Indeed, for the majority of authors, this dimension
is composed of positive emotions and emotional states, while for others it includes
depression and anxiety through negative affective states [102].
However, it is not a question of diagnosing depression or anxiety with the quality-of-life
scale, the emotional component is part of the mental quality of life but it is only represented
by a few items that do not allow an evaluation sufficient anxiety-depressive state. It is
therefore more relevant to differentiate these concepts and to limit ourselves here to positive
or negative emotions or affects.
The average duration of hemodialysis in this study was 15.03±12.82 months. This result is
much lower than those reported by Speyer E. et al. in France (72 months), Sabi KA et al in
Togo (66 months), Yi-Nan Li et al in China (54 months - 45) and Diallo D et al in Mali (54
months) [67, 82-4, 89]. Certainly, the low availability of this treatment in the country does
not allow its early use by patients. There is a low percentage of hemodialysis patients doing
3 hemodialysis sessions per week (32%), while studies conducted by Vasilopoulou C et al.
in Greece (2016), Collister D et al in Canada (2018) and Lobna Aribi et al in Tunisia (2015),
found 1.8%, 4% and 18% of patients doing less than 3 hemodialysis sessions per week [17-
9]. Funding for hemodialysis was provided by the family or oneself at 63%.
This corroborates the studies conducted in Cameroon (2017) by Fouda Hermine et al [8]
where funding for hemodialysis was 91% provided by the family or oneself. Indeed, in
DRC, dialysis sessions are expensive ($50 to $250/dialysis session) [103], nearly 50% of
people live on less than US$1 per day, a GDP of US$68/habitant/year, a guaranteed
interprofessional minimum wage (SMIG) of US$5/day and 71% of people affected by
increased poverty [104]. Under these conditions no patient could be observing dialysis.
Unlike in developed countries such as France, where care is in the majority of cases covered
100% by health insurance [92].
CONCLUSION
This study, which assessed the anxiety, depression and quality of life of 100 chronic
hemodialysis subjects in Kinshasa, found that Kinois hemodialysis are predominantly
elderly under 60, male, professionally active, academic, married and without medical
insurance; HBP and diabetes mellitus are the two major medical histories; Depression,
anxiety and impaired quality of life are present in chronic hemodialysis in Kinshasa;
Diabetes mellitus is associated with depression while age, sex, education level and duration
of hemodialysis are associated with impaired quality of life. The mental health component is
paradoxically less impaired in depressed or anxious hemodialysis than it is in those where
depression and anxiety are clinically insignificant.
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Acknowledgement
The author appreciates all those who participated in the study and helped to facilitate the
research process.
Conflict of Interest
The author declared no conflict of interest.
How to cite this article: Dalida K.N, Samuel M.M.M, Benjamin L.M, Alex T.K.H., Degani
B.B, Moïse M.M, Abraham M.M & Aliocha N.N. (2020). Anxiety, depression and quality of
life among adult patients in Kinshasa, Democratic Republic of Congo. International Journal
of Indian Psychology, 8(4), 1053-1070. DIP:18.01.124/20200804, DOI:10.25215/0804.124
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