Patient perceived barriers to treatment of depression and anxiety in hemodialysis patients.

Untreated psychiatric illness correlates with increased mortality, reduced quality of life and increased risk of suicide in renal failure patients, but little is known about why these patients fail to seek mental health care. The purpose of this study was to identify the perceived barriers to mental health services in the hemodialysis patient population. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to identify the prevalence and severity of depression and anxiety in a group of 179 hemodialysis patients. Of the 103 patients who completed the surveys, 73.8% were African-American and 62.1% were male. Of the 54.4% of patients identified with depression by scoring 10 or greater on the BDI, 34.0% had mild-to-moderate, 12.6% had moderate-to-severe, and 7.8% had severe depression. Only 13.6% of respondents met criteria for anxiety. Each patient was asked to choose from a list of possible barriers, and 71.4% of patients meeting criteria for depression or anxiety identified a barrier to mental health treatment. Of these, over 70% of patients were unaware of symptoms of depression/ anxiety or did not perceive the need for help. Our results indicate a high prevalence of untreated depression in hemodialysis patients. Patient perceptions of the need for therapy present the most significant barriers to identification and treatment.