Prevalence of anxiety in patients with kidney disease and its associated factors based on Bronfenbrenner's ecological model.

Abstract

Introduction: In patients with kidney disease, anxiety is considered a common emotional disorder due to significant life changes, the nature of the illness itself, and the urgent need to initiate hemodialysis to sustain life. The objective of this study was to identify existing research on the prevalence of anxiety among renal patients in Hispanic countries and the psychometric instruments used to assess this variable. Furthermore, applying Bronfenbrenner’s Ecological Model, the study aimed to highlight factors that could trigger and perpetuate anxiety disorders within this population.

Materials and Methods: A literature review was conducted covering studies published over the last 10 years regarding anxiety prevalence in patients with kidney disease in Hispanic countries. These studies were sourced from databases such as SciELO, PubMed, Scopus, Springer, and Google Scholar, alongside two doctoral theses.

Results: The review identified anxiety prevalence estimates among patients with chronic kidney disease ranging from 21.4% to 93% in Hispanic countries. Moderate to high severity levels predominated, with greater vulnerability observed in women and patients who had been on hemodialysis for longer periods. The most frequently used assessment tools were the Hospital Anxiety and Depression Scale (HADS), the Beck Anxiety Inventory (BAI), and the Hamilton Anxiety Rating Scale. Key factors linked to anxiety included clinical and biological variables (body mass index, comorbidities, and sleep disturbances) and psychosocial aspects (coping styles, loss of independence, role changes, and family support networks), as well as treatment-related stressors such as noise from hemodialysis equipment and financial costs. Urie Bronfenbrenner’s (1917–2005) Ecological Systems Theory—also known as the Ecological Model—allows for the identification and evaluation of elements within the person-environment dyad that exert a direct or indirect influence.

Conclusions: The prevalence of anxiety among renal patients was corroborated by the findings of studies used in this work, confirming a high incidence rate of this emotional disorder. Assessing the emotional state of individuals with chronic kidney disease undergoing hemodialysis is essential. Bronfenbrenner’s Ecological Model offers a valid and transferable alternative for research and psychological practice (psychodiagnosis and psychotherapy) involving renal patients. In Ecuador, scientific evidence regarding psychological practice for this population remains scarce.