Prevalence and associated factors of anxiety and depression among hemodialysis patients in palestine: a cross-sectional study

Patients with end-stage renal disease (ESRD) undergoing hemodialysis are at increased risk of anxiety and depression, which may adversely affect treatment adherence and quality of life. Data on the prevalence and determinants of these conditions among Palestinian hemodialysis patients remain limited outside pandemic settings. A cross-sectional study was conducted among 435 adult hemodialysis patients consecutively recruited from four dialysis centers in the West Bank, Palestine, between December 2025 and January 2026. Data were collected using interviewer-administered questionnaires covering sociodemographic characteristics, clinical and dialysis-related factors, perceived social support, and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics were performed, followed by chi-square and Kruskal-Wallis tests. Multivariable linear regression analyses were used to identify factors independently associated with anxiety and depression scores. The median age was 55 years, with equal representation of men and women. Most participants lived in villages (60.9%), were married (67.4%), had primary or secondary education, reported low income (61.6%), and were unemployed (77.2%). The majority used arteriovenous fistulas for vascular access (66.9%), with a median dialysis duration of 36 months. Abnormal anxiety and depression were identified in 31.5% and 40.2% of participants, respectively, while borderline symptoms were present in 24.4% and 36.3%. Higher education, medium income, better perceived social support, and catheter vascular access were independently associated with lower anxiety scores. Higher depression scores were associated with longer dialysis duration, higher weekly dialysis frequency, diabetes mellitus, lower educational level, and poor social support. Age, sex, and most comorbidities were not independently associated with psychological outcomes. Anxiety and depression are highly prevalent among Palestinian hemodialysis patients. Psychosocial and sociodemographic factors-particularly education, income, and social support-appear to have a greater influence on mental health than most biomedical variables. Routine psychological screening and integrated psychosocial interventions should be incorporated into hemodialysis care.