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Title: Depression and associated factors in Chinese patients with chronic kidney disease without dialysis : a cross-sectional study
Authors: Duan, D 
Yang, L 
Zhang, M
Song, X
Ren, W
Issue Date: May-2021
Source: Frontiers in public health, May 2021, v. 9, 605651
Abstract: Background: Chronic kidney disease (CKD) has been a globally public health problem over the past decades. The maintenance of physical and mental health is of importance for patients nowadays. Notably, depression is prevalent and associated with various adverse events in CKD patients without dialysis. Prior studies have reported that pain, negative illness perception, pain, and low self-esteem are potential risk factors of depression, while few studies have comprehensively investigated the mechanisms among these factors and depression among this population.
Purpose: This study aims to investigate the prevalence of depression and further explore the factors associated with depression among CKD patients without dialysis in China.
Design and Methods: We conducted a cross-sectional study in patients with diagnosed CKD to investigate the prevalence of depression was by the Beck Depression Inventory-II (BDI-II). The data on pain interference, illness perception, and self-esteem were also collected via self-administered questionnaires. A structural equation model (SEM) was used to examine the factors associated with depression.
Main Findings: From June to October 2019, we successfully interviewed 334 CKD patients at the outpatient clinics. Their mean age was 45.6 years (ranging from 19 to 74 years), and 48.5% were male. Most respondents were at early CKD stages (77.5% stage 1–3) and the prevalence of depression was 22.2%. We found a moderate association between illness perception and depression, which was modified by self-esteem. Similar but weaker association was found between pain interference and depression.
Conclusion and Recommendations: Negative illness perception, low self-esteem and severe pain interference were associated with depression among Chinese CKD patients without dialysis. Future studies are warranted to investigate the underlying mechanism and formulate the intervention strategies for this high-risk population.
Keywords: Chronic kidney disease
Illness perception
Pain perception
Publisher: Frontiers Research Foundation
Journal: Frontiers in public health 
ISSN: 2296-2565
DOI: 10.3389/fpubh.2021.605651
Rights: © 2021 Duan, Yang, Zhang, Song and Ren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) ( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The following publication Duan D, Yang L, Zhang M, Song X and Ren W (2021) Depression and Associated Factors in Chinese Patients With Chronic Kidney Disease Without Dialysis: A Cross-Sectional Study. Front. Public Health 9: 605651 is available at
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