Depression and Marital Discontent among Hemodyalsis Patients and their Spouses in Pakistan

Background: Marital dyad is an interdependent unit, wherein the depression and marital discontent experienced by the patient on maintenance hemodialysis (MHD) influences the non-patient spouse. Objective: To determine the severity of depression and level of marital discontent among patients on MHD and their spouses and the effect of depression on marital adjustment. Methods: This cross sectional study was conducted at Nephrology Department, Mayo Hospital, Lahore from October 2023 to March 2024. Ninety-Four married couples in whom one partner was on MHD for ≥3 months were included in the study. The degree of depression was assessed using Beck Depression Inventory (BDI) whereas marital adjustment was determined using Revised Dyadic Adjustment Scale(RDAS). Results: Of the 94 couples, 60% patients and 42.5% spouses reported mild to moderate or severe depression, with poor marital adjustment present in 47.8% patients and 44.6% of the spouses. Patient’s depression correlated with spousal depression(r=0.655, p<0.01) and RDAS scores of both the patient and their spouse(r=-0.628, p<0.01). In addition, spouse’s depression correlated negatively with their own RDAS score. Couples in joint families had lower levels of depression and marital adjustment, as indicated by higher RDAS score. Conclusion: In this study, degree of depression in patient on MHD showed a strong correlation with depression in non-patient spouse. Severe depression in patients resulted in poor marital adjustment for both the patients and their spouses. Marital discontent and depression in both the patient and spouse were affected negatively by poor socioeconomic conditions and positively by social support in the form of joint family system.