Page 17 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Stigma in maintenance hemodialysis patients

medical model. Hemodialysis can save the lives of those into two modules: internalized stigma and enacted
suffering from ESRD, but the therapy itself also brings stigma. Internalized stigmas includes 13 items regarding
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psychological and symptom burdens that impair the self-perception (e.g., embarrassment and self-blame).
quality of life and prognosis. Presently, there are few Enacted stigma includes 11 items regarding the unkind
6,7
reports on stigma in patients with ESRD. The present attitude of others toward the patients (e.g., avoiding
study aims to understand the situation of stigma in and discrimination). The Likert rating system is used to
patients undergoing hemodialysis and explore the effect of score 1 – 5 points based on the options of “no,” “rarely,”
stigma on their quality of life. Furthermore, we attempt to “sometimes,” “often,” and “always,” with a total score of
identify possible predictors associated with the occurrence 24 – 120 points. A higher score represents a higher degree
of stigma in these patients. This may help nephrologists of stigma. The SSCI instrument has satisfactory content
develop strategies to alleviate this psychological condition validity and internal consistency and is considered a generic
and improve their quality of life. tool to measure stigma in different chronic illnesses. 10
2. Methods 2.4. Evaluation of depression and anxiety

2.1. Participants The Beck Depression Inventory (BDI) and Beck Anxiety
Inventory (BAI) were used to evaluate the degree of
All maintenance hemodialysis patients registered at the depression and anxiety. 11-13 Both the BDI and BAI contain
Blood Purification Center of Jinshan Hospital, affiliated 21 questions, which are effective in diagnosing depression
with Fudan University, in January 2023 were regarded as and anxiety in many studies, especially in patients with
candidates. Inclusion criteria were as follows: (i) patients chronic somatic diseases. 14,15 Each question has four
with ESRD undergoing hemodialysis for at least 3 months; options: 0 – 3. The cumulative score range of all items is
(ii) willingness to participate in the study and sign an
informed consent; and (iii) ability to read. Patients 0 – 63. A higher score represents more severe symptoms.
experiencing severe acute complications were excluded 2.5. Measurement of quality of life
from this study. This study adhered strictly to the principles
outlined in the Declaration of Helsinki (2013) (approval We utilized the medical outcomes study 36-item
no. JIEC2022-S83). short-form health survey (SF-36) to measure the quality
of life. The scale consists of eight modules: physical
2.2. Data collection and definitions functioning, role-physical, bodily pain, general health,
We collected data using medical records and self-reported vitality, social functioning, role-emotional, and mental
questionnaires, which included: (i) Epidemiological health. Each module has a score range of 0 – 100. A higher
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information: age, gender, household location, marital score represents a higher level of quality of life.
status, children’s status, living arrangements (alone or 2.6. Statistical analysis
with others), education level, occupations, religious
belief, etc.; (ii) clinical information: primary diseases, Quantitative data were expressed as mean ± standard
duration of dialysis, blood pressure, status of kidney deviation (SD), while categorical data were expressed as
transplantation candidacy, types of daily oral medications frequency and percentage (n; %). Pearson correlation
(e.g., antihypertensives, furosemide, sodium bicarbonate), analysis was employed to examine the correlation between
Charlson comorbidity index (CCI), dysfunction of vascular stigma and quality of life. Multiple linear regression analysis
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access, residual urine volume, presence of uremic pruritus, was used to identify the predicted factors associated with
and restless legs syndrome; (iii) lifestyle information: internalized stigma and enacted stigma, respectively. We
smoking and drinking habits, engagement in social and adopted the SPSS software version 23.0 to analyze the data,
recreational activities, and commuting time to dialysis with statistical significance set at P < 0.05.
facilities; and (iv) recent laboratory data: hemoglobin 3. Results
(Hb), calcium (Ca), phosphorus (P), parathyroid hormone
(PTH), albumin (Alb), prealbumin (preAlb), triglyceride After screening, 115 patients were enrolled in this study,
(TG), total cholesterol (Chol), and dialysis adequacy with an average age of 52.14 ± 11.84 years and 74 (64.35%)
indicators (Kt/V and urea reduction ratio [URR]). being male. Most patients were married (n = 84; 73.04%)
and had children (n = 103; 89.57%). The average duration
2.3. Evaluation of stigma of hemodialysis was 89.73 ± 64.79 months. The average
The Stigma Scale for Chronic Illness (SSCI), comprising value of the CCI was 3.13 ± 1.75, and 13.91% of patients were
24 items, was utilized to assess the level of stigma in awaiting transplantation. The average scores for BDI and BAI
patients undergoing incident dialysis. The scale is divided were 18.11 ± 12.15 and 9.41 ± 9.85, respectively (Table 1).

Volume 2 Issue 4 (2024) 2 doi: 10.36922/jcbp.2181