Frequency of depressive symptoms in Syrian refugees and Turkish maintenance hemodialysis patients during COVID-19 pandemic

Introduction: Pneumonia of unknown cause was detected on 30 December 2019
in China. It was categorized as an outbreak and named as COVID-19 by the
World Health Organization. The pandemic affects all people, but patient
groups such as hemodialysis (HD) patients have been particularly affected.
We do not know if refugees suffered more during the outbreak. In this
study, we compared depressive symptom frequency between Syrian refugee HD
patients and Turkish ones. Methods: The study had a single-center,
cross-sectional design. Demographic and clinical data were collected
retrospectively from patients’ files containing details about past medical
history, demographic variables and laboratory values. Validated Turkish
and Arabic forms of Beck Depression Inventory (BDI) were used to assess
depressive symptoms. BDI scores were compared according to nationality,
demographic features and clinical data. A BDI score more than 14 was
accepted as suspicion of depression. Results: 119 patients were enrolled
in the study. After the exclusion of 22 patients, 75 Turkish and 22 Syrian
patients were included for further analysis. The median BDI (interquartile
range) score for Turkish and Syrian patients were 12 (7-23) and 19.5
(12.7-25.2), respectively (p=0.03). Suspicion of depression was present at
42.7% of Turkish, and 72.7% of Syrian HD patients (p=0.013). Regarding all
patients, phosphorus level, Kt/V, and nationality were significantly
different between patients with and without suspicion of depression
(p=0.023, 0.039, 0.013, respectively). Conclusion: Syrian patients had
higher BDI scores and more depressive symptoms than Turkish patients.
Additional national measures for better integration and more mental
support to Syrian HD patients are needed.

引言：2019年12月30日，中国检出病因不明的肺炎病例。世界卫生组织（World Health Organization）将该疫情归类为突发公共卫生事件，并将其命名为新型冠状病毒肺炎（COVID-19）。这场全球大流行波及所有人群，但血液透析（hemodialysis，HD）患者群体受影响尤为严重。目前尚不清楚难民群体在疫情期间是否承受了更沉重的健康与心理负担。本研究对比分析了叙利亚难民血液透析患者与土耳其本土血液透析患者的抑郁症状发生频率。
研究方法：本研究采用单中心横断面研究设计。研究人员通过回顾性调取患者病历档案收集数据，档案内容涵盖既往病史、人口统计学变量及实验室检测指标。本研究使用经过验证的土耳其语与阿拉伯语版贝克抑郁自评量表（Beck Depression Inventory, BDI）评估抑郁症状。研究人员依据国籍、人口统计学特征及临床数据对BDI评分进行组间比较，将BDI评分＞14作为抑郁可疑的判定标准。
研究结果：本研究共纳入119例患者。排除22例不符合纳入标准的病例后，最终纳入75例土耳其患者与22例叙利亚患者开展后续分析。土耳其患者与叙利亚患者的BDI评分中位数（四分位间距）分别为12（7~23）与19.5（12.7~25.2），组间差异具有统计学意义（p=0.03）。土耳其患者与叙利亚患者的抑郁可疑检出率分别为42.7%与72.7%，组间差异具有统计学意义（p=0.013）。针对全部研究对象的亚组分析显示，抑郁可疑组与非抑郁可疑组在血磷水平、Kt/V值及国籍方面差异均具有统计学意义（分别对应p=0.023、0.039、0.013）。
研究结论：本研究结果表明，叙利亚难民血液透析患者的BDI评分更高，抑郁症状发生率显著高于土耳其本土患者。因此，亟需出台针对性的国家层面举措，以优化叙利亚难民血液透析患者的社会融入，并为其提供更充分的心理支持。