An ongoing, prospective multicenter study found that the COVID-19 pandemic has not had a major influence on the mental health of the majority of patients on hemodialysis. These findings were published in the Journal of Psychosomatic Research.

Data were sourced from the DIVERS-II study which was launched prior to the pandemic with the goal of investigating the effectiveness of self-help problem-solving therapy for depressive symptoms among patients on hemodialysis. For this analysis, COVID-19-related stress was evaluated during the first and second waves in the Netherlands using the Perceived Stress Scale–10 (PSS-10), Beck Depression Inventory–second edition (BDI-II), Beck Anxiety Inventory (BAI), and Short Form–12 (SF-12) and compared with prepandemic scores.

Patients (N=121) were aged mean 67±13 years, 69% were men, 45% were married, 75% had children, 88% were not employed, in addition, they had been receiving dialysis for a median of 23 (interquartile range [IQR], 9-42) months, 27% were on the waiting list for a kidney transplant, 14% had high comorbidity, and 10% a history of depressive disorder.

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During the first wave, 23 patients were tested for SARS-CoV-2 and no patient tested positive; however, 2 patients were admitted to the hospital with COVID-19-like symptoms. During the second wave, 13 patients were tested and 5 (10%) were positive. One patient during wave 2 was admitted to the hospital and 1 was admitted to a nursing home. No COVID-19 mortality was reported.

Compared with prepandemic measures, BDI-II depression scores (mean difference [MD], -0.9; 95% CI, -2.0 to 0.1; P =.09), BAI anxiety scores (MD, -1.0; 95% CI, -2.5 to 0.6; P =.21), SF-12 physical component scores (MD, 0.37; 95% CI, -2.1 to 2.8; P =.76), and SF-12 mental component scores (MD, 0.1; 95% CI, -1.7 to 2.0; P =.88) were not significantly different during the first COVID-19 wave. Similar results were found during the second COVID-19 wave.

The average overall PSS-10 scores were 11.0±6.4 and 11.7±7.6 points during the first and second COVID-19 waves, respectively. A third of patients (33%) during wave 1 and 37% during wave 2 thought their perceived stress was due to COVID-19. Individuals who reported COVID-19-related stress had higher PSS-10 overall and negative subscale scores than those without COVID-19-related stress in both waves (all P ≤.006).

Stratified by perceived COVID-19 stress, patients with pandemic-related stress had a higher BDI-II (MD, 4.9; 95% CI, 0.7-9.0; P =.021) and lower SF-12 mental component (MD, -5.3; 95% CI, -9.0 to -1.6; P =.006) scores.

This study was limited by the low patient retention (n=50) during wave 2.

“In conclusion, the COVID-19 pandemic does not seem to influence severity of symptoms of depression, anxiety, and quality of life in hemodialysis patients during the first and second COVID-19 wave in the Netherlands, compared to pre-pandemic data. However, a substantial subgroup of patients with pre-existent higher symptom levels of depression and lower mental health-related quality of life may be more susceptible to experience COVID-19 related stress,” stated the authors.


Nadort E, Rijkers N, Schouten RW, et al. Depression, anxiety and quality of life of hemodialysis patients before and during the COVID-19 pandemic. J Psychosom Res. 2022;158:110917. doi:10.1016/j.jpsychores.2022.110917