Academic Journal
Evaluating the inter-relationships among depression, anxiety and somatic symptoms in haemodialysis patients: a cross-sectional structural equation modelling study.
| Title: | Evaluating the inter-relationships among depression, anxiety and somatic symptoms in haemodialysis patients: a cross-sectional structural equation modelling study. |
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| Authors: | Krishna A; Department of Epidemiology, University of Florida, Gainesville, Florida, USA anika.krishna@ufl.edu., O'Donnell K; Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA., Dolata J; Center for Health Care Research and Policy, Population Health Research Institute, The MetroHealth System, Cleveland, Ohio, USA., Figueroa M; Center for Health Equity Engagement, Education and Research, Population Health Research Institute, The MetroHealth System, Cleveland, Ohio, USA., Sajatovic M; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.; Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA., Sehgal AR; Center for Health Equity Engagement, Education and Research, Population Health Research Institute, The MetroHealth System, Cleveland, Ohio, USA.; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.; Institute for Health, Opportunity, Partnership, and Empowerment, The MetroHealth System, Cleveland, Ohio, USA., Gunzler DD; Center for Health Care Research and Policy, Population Health Research Institute, The MetroHealth System, Cleveland, Ohio, USA.; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. |
| Source: | BMJ open [BMJ Open] 2026 Jun 28; Vol. 16 (6), pp. e113939. Date of Electronic Publication: 2026 Jun 28. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| MeSH Terms: | Renal Dialysis*/psychology , Depression*/epidemiology , Anxiety*/epidemiology , Kidney Failure, Chronic*/therapy , Kidney Failure, Chronic*/psychology , Medically Unexplained Symptoms*, Ohio/epidemiology ; Humans ; Female ; Male ; Cross-Sectional Studies ; Middle Aged ; Aged ; Quality of Life ; Latent Class Analysis ; Adult ; Surveys and Questionnaires ; Patient Health Questionnaire |
| Abstract: | Background: Somatic symptoms frequently occur in haemodialysis patients, whereas depression and anxiety are also common but are often under-recognised issues. This study aims to examine the associations among depression, anxiety and somatic symptoms in haemodialysis patients. These symptoms may be linked together under a general distress construct in haemodialysis patients. Methods: We surveyed 1085 dialysis patients between 1 March 2018 and 28 February 2023 at 17 dialysis facilities in Northeast Ohio with the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder and Kidney Disease Quality of Life instrument somatic questions. To evaluate associations across these multi-item questionnaires, we used latent variables and a structural equation modelling approach. We first compared single-factor, two-factor and three-factor models. We next considered bifactor and higher order factor models. We controlled for race, gender and age in all models. Results: Our study sample included a high percentage of black patients (75%) and 150 (14.3%) survey participants screened positive for depression (PHQ-9 ≥10). All models fit relatively well, with the three-factor model fitting slightly better than the single and two-factor models. In the three-factor model, the associations for depression and anxiety (r=0.818), depression and somatic (r=0.800) and anxiety and somatic (r=0.784) were all high, potentially indicative of poor discriminant validity. We found that the bifactor model fit the best of the five models tested (comparative fit index=0.957, Tucker-Lewis fit index=0.959, root mean square error of approximation=0.043) and was the most substantively meaningful, with an overall internalising construct and specific domains explaining additional covariance across the questions. Being black (vs all other races), male (vs female) and older age all had significantly (p<0.05) lower levels of reported symptoms on most constructs. Conclusion: We found very strong associations among depression, anxiety and somatic symptoms in our sample of haemodialysis patients. All questionnaire items may be linked together under a common general distress disorder, while each still retains unique features of depression, anxiety and somatic symptoms not fully explained by internalising processes. Patient care approaches should generally consider screening for all three together, rather than only one. (© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: DDG receives royalties from Taylor & Francis Publishing and has served as a consultant to BioSensics and Massachusetts General Hospital. MS has received grant support from Nuromate, Otsuka, Alkermes, the International Society for Bipolar Disorders, the National Institutes of Health, the Centers for Disease Control and Prevention and the Patient-Centered Outcomes Research Institute; has served as a consultant to Otsuka, Janssen, Alkermes, Myriad, Frontline Medical Communications and Health Analytics; receives royalties from Springer Press, Johns Hopkins University Press, Oxford Press and UpToDate; and receives compensation for the preparation of continuing medical education activities from the American Physician’s Institute, MCM Education, CMEology, Potomac Center for Medical Education, Global Medical Education, Creative Educational Concepts and the Psychopharmacology Institute. |
| Contributed Indexing: | Keywords: Anxiety disorders; Clinical Relevance; Depression & mood disorders; Dialysis; MENTAL HEALTH |
| Entry Date(s): | Date Created: 20260628 Date Completed: 20260628 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13311719 |
| DOI: | 10.1136/bmjopen-2025-113939 |
| PMID: | 42366010 |
| Database: | MEDLINE |
| ISSN: | 2044-6055 |
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| DOI: | 10.1136/bmjopen-2025-113939 |