Adult Separation Anxiety in Chronic Kidney Disease: Psychosocial, Clinical, and Relational Correlates—A Multicentre Cross-Sectional Study

Background and Objectives: Adult separation anxiety (ASA) has received limited attention in nephrology despite the substantial psychological burden associated with chronic kidney disease (CKD). We examined ASA in CKD in relation to depressive symptoms, parental bonding, perceived expressed emotion, CKD stage, and dialysis status. Materials and Methods: In this multicentre cross-sectional study, 340 adults with CKD (169 dialysis, 171 non-dialysis) were recruited from two tertiary care centres. ASA was assessed with the Adult Separation Anxiety Questionnaire (ASA-27), alongside the Parental Bonding Instrument, Level of Expressed Emotion Scale–Short Form, Beck Depression Inventory (BDI), and Short Form-36 Health Survey. Group comparisons, correlations, multivariate analysis of covariance, and hierarchical linear regression were performed. Results: ASA correlated positively with depressive symptoms (rho = 0.450), maternal overprotection (rho = 0.412), expressed emotion (rho = 0.336), paternal overprotection (rho = 0.326), and CKD stage (rho = 0.166) and negatively with paternal care (rho = −0.212). Dialysis patients had higher ASA and depressive symptom scores, but these differences did not persist once CKD stage was entered as a covariate (p = 0.169 and p = 0.053), reflecting the near-complete overlap between dialysis status and stage 5 disease. Younger age, female sex, higher maternal overprotection, and greater depressive symptom severity were independently associated with higher ASA scores (adjusted R2 = 0.285). Conclusions: ASA appears clinically relevant in CKD and is associated with depressive symptoms and relational factors. Psychosocial assessment in CKD should extend beyond depression. The higher ASA levels observed in dialysis patients cannot be attributed to dialysis treatment itself.