Coping with mental health status: Experiences of end-stage renal disease patients undergoing hemodialysis at Hospital Pakar USM, Malaysia

Abstract

The prevalence of chronic kidney disease (CKD) in Malaysia has increased from 9% in 2011 to 15.5% in 2022. Approximately 28 Malaysians start dialysis treatment daily, and more than 55,000 CKD patients are currently undergoing dialysis nationwide, frequently experiencing mental health symptoms, including depression, anxiety, emotional stress, and cognitive dysfunction, which negatively affect their quality of life and daily functioning. These mental health symptoms are also exacerbated by the physical toll of the disease and the invasive nature of dialysis treatment. CKD impacts physiological and sociological well-being; consequently, coping strategies vary, with patients utilizing both problem-focused and emotion-focused approaches to manage the illness. This study employed a qualitative method which is a semi-structured interviews with five purposively selected participants to explore emotional challenges and coping strategies via thematic analysis. Qualitative themes revealed a heavy 'mental load' and life disruption, countered by resilience through spiritual coping and peer validation. Seven themes have emerged, including: (1) mental load and emotional distress, (2) life disruption and loss of freedom, (3) physical exhaustion and bodily suffering, (4) social isolation and altered relationships, (5) identity change and self-perception, (6) coping, adaptation, and resilience, and (7) gratitude and meaning-making. Qualitatively, findings revealed that "mental load" is characterized by life disruption, identity changes, and physical exhaustion. However, patients also demonstrated remarkable resilience through "meaning-making," spiritual coping, and peer validation, which served as protective factors against total emotional collapse. This study underscores that while physical treatment is standardised, the psychological burden of hemodialysis is deeply personal and multifaceted. The persistence of high stress and anxiety levels in specific subgroups necessitates the integration of routine mental health screening and targeted psychosocial interventions. Future research should address socio-economic barriers as vital as clinical management in improving the quality of life for CKD patients.

Qualitative themes revealed a heavy 'mental load' and life disruption, countered by resilience through spiritual coping and peer validation. Seven themes have emerged, including: (1) mental load and emotional distress, (2) life disruption and loss of freedom, (3) physical exhaustion and bodily suffering, (4) social isolation and altered relationships, (5) identity change and self-perception, (6) coping, adaptation, and resilience, and (7) gratitude and meaning-making. Qualitatively, findings revealed that "mental load" is characterized by life disruption, identity changes, and physical exhaustion. However, patients also demonstrated remarkable resilience through "meaning-making," spiritual coping, and peer validation, which served as protective factors against total emotional collapse.This study underscores that while physical treatment is standardised, the psychological burden of hemodialysis is deeply personal and multifaceted. The persistence of high stress and anxiety levels in specific subgroups necessitates the integration of routine mental health screening and targeted psychosocial interventions. Future research should address socio-economic barriers as vital as clinical management in improving the quality of life for CKD patients.