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. 

Methods
Demographic data were collected retrospectively from patients’ files. Age, sex, nationality, marital status, education level, height, weight, etiology of kidney disease, the date for initiation of center HD, last hemoglobin, albumin, phosphorus, parathyroid hormone, Kt/v, creatinine levels, Charlson comorbidity index were noted. Marital status was grouped as married and others including single, divorced, and widow.

BDI consists of 21 questions and every question has four choices pointed from 0 to 3 in which 0 represents the absence of a problem, and 3 represents an extreme problem. Therefore, the total BDI score can be between 0 and 63 points. BDI score of more than 14 was accepted as depression in patients with end-stage renal disease (ESRD). The frequency of depression was compared between nationalities.  Validated Turkish and Arabic BDI forms were filled by patients themselves. In the need of help, native Arabic physician working at our hemodialysis center (SS) and official Arabic translator of our institution (SA) have helped Syrian patients. BDI score was also divided into cognitive-affective and somatic-performance subscales. These were compared to nationality as well. 

BDI score was compared according to the age groups (<65 years or ≥65 years), sex, education level, marital status, body mass index (<25 kg/m2, 25-30 kg/m2, >30 kg/m2 ), presence of diabetes mellitus, presence of hypertension, HD vintage (below or above median), hemoglobin level (<10 g/dl, 10-12 g/dl, >12 g/dl), phosphorus level (<3.5 mg/dl, 3.5-5.5 mg/dl, >5.5 mg/dl), albumin level (<3.5 gr/dl or ≥3.5 gr/dl), parathyroid hormone level (below or above median), Kt/v (<1.4 or ≥1.4), and nationality.