PSYCHOLOGICAL DISTRESS AND PHYSICAL MULTIMORBIDITY - THE EXAMPLE OF COEXISTING DIABETES MELLITUS AND END-STAGE RENAL DISEASE

Abstract

Introduction: Patients with coexisting Diabetes Mellitus and End-Stage Renal Disease (DM-ESRD) represent the fastest growing and most frail segment of the ESRD population. Multimorbidity can lead to psychological distress, intensify illness perception, impair nutritional Quality of Life (QOL), health literacy and adherence to treatment, but evidence is largely lacking. The study aimed to document prevalence and factors associated with psychological distress outcomes in DM-ESRD.

Methods: This was a mixed-methods study involving N=31 interviews and a cross-sectional questionnaire survey with N=171 DM-ESRD patients using: the Hospital Anxiety and Depression Scale, UCLA Loneliness Scale, Beck Hopelessness Inventory, and measures of Health Literacy, Illness/Treatment Perception, Nutritional Quality-of-Life, and Adherence.

Results: Interpersonal tension and challenges related to diet/appetite dominated patients’ narratives. Survey data indicated considerable range of distress (46% ; 53%; 79%; 53% for depression, anxiety, loneliness & hopelessness). Multivariate modelling predominantly revealed that Health Literacy dimensions and Nutrional QOL were associated with distress indicators.

Conclusion: DM-ESRD patients find diet and health care communication/navigation challenging and experience psychological distress. Carefully tailored interventions are needed.