UNIVERSITI TEKNOLOGI MARA

RELIGIOSITY, DEPRESSION AND COGNITIVE IMPAIRMENT AMONG

HEMODIALYSIS PATIENTS IN HOSPITAL KUALA LUMPUR

DR. NOR JANNAH NASUTION BINTI RADUAN

Dissertation submitted in partial fulfillment of the requirements for the degree of Master of Medicine (Psychiatry)

Faculty of Medicine

May 2016

DECLARATION

Hereby I, Dr.Nor Jannah Nasution binti Raduan, declare the work in this thesis is

solely my doing, except for the quotations and usual scientific noting from other

studies, which has been referenced.

1st February 2016

Dr.Nor Jannah \asufjon bsnti Rdduan

20IISOI7I4

file:///asufjon

CERTIFICATION

This is to certify that the candidate, Dr.Nor Jannah Nasution binti Raduan has carried out this research project, and to the best of my knowledge this dissertation is entirely her work.

Principal Supervisor

WL MOH0 fWZAU SAiLlM MMC Ful Rtgivtrtflon Ho: 23229

Professor M Professor o f Psychia Ps\ et io logical and Med ic ine Uni t Faculty o f Med ic tne l ' n i \ e r * i t i I eknoloui Mara

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ACKNOWLEDGEMENT

In the name of Allah, The Most Merciful, The Most Gracious. All praise is due to Allah for all the strength, patience, determination and ideas bestowed upon me to fulfill this research.

I am highly grateful to my supervisors Prof. Dr. Mohd Razali Salleh and Datuk Dr. Ghazali Ahmad, for all the guidance, patience and encouragement throughout the journey of completing this research study. I am ever so thankful. Special thanks and highest appreciation to Dr. Zaleha, my statistician, for guiding me patiently throughout my data analysis, without whom this research could have never been completed.

Not to forget, sincere thanks to the Head of Department, Prof. Dr. Syed Hassan Ahmad, for the continuous support in completing this study. Special thanks also to all the lecturers in PBM Unit UITM, psychiatrists in Hospital Selayang, Puan Nur Maizura and Puan Hezlin from UITM for the guidance in writing and statistics.

A sincere thank you goes to Sister Zanariah Arsat, sister in charge of hemodialysis unit of HKL for all her assistance in making my data collection smooth, to all staff nurses and medical assistants who tirelessly assisted me throughout this research in the hemodialysis Unit. To all the patients who had agreed to participate in this research study, May God the Almighty grant each and every one of you with the best in this world and the next, for all your support and patience. I have learnt what patience truly meant through my short journey with all the hemodialysis patients and each one of you is indeed a real hero.

No words can describe my appreciation to my family members. I could not have completed this journey without the solid support and patience of my beloved husband and my two boys, who had unwillingly allowed me to sacrifice my family time to complete this task. My determination was always fueled by the two special people who never saw failure in me, Ayah and Mama, may Allah reward you both with Paradise. Thank you to my siblings, my parents' in-law and my peers in UITM and UKM Support Group and to all Medical Officers in Psychiatry Department, Hospital Selayang for your cooperation. Only God the Almighty can reward each and every one of you for your kindness.

I hope and pray that this research study would be a stepping-stone for me to pursuit more research and enhance the beauty of spirituality in medicine and health.

IV

ABSTRACT

Background: Depression and Cognitive impairment are two most common complications of patients on hemodialysis. Religiosity has been found to have a positive effect and minimized these problems. Objective: To study religiosity and its relationship with depression and cognitive impairment among hemodialysis patients in Hospital Kuala Lumpur. Methodology: This is a cross-sectional study involving 110 hemodialysis patients in Hospital Kuala Lumpur. The samples were recruited through universal sampling. The assessments were done during the dialysis treatment and within two hours of the hemodialysis. The patients were assessed with Beck Depression Inventory- Malay (BDI), Malay Mini International Neuropsychiatric Interview - Malay (MINI), Malay Montreal Cognitive Assessment (MOCA) and Duke University Religious Index Malay (DUREL-M). Descriptive analysis was performed, followed by multiple logistic regression analysis. Results: This study found that 18.2% patients had depression and 48.2% had cognitive impairment. The factors significantly associated with depression were patients having no current episode of depression in M.I.N.I Depression (OR= 0.047; 95% CI= 0.012-0.176), unmarried status (OR= 3.906; 95% CI= 1.409-10.830), high intrinsic religiosity (OR= 0.329, 95% CI= 0.116-0.935) and low education level (OR= 3.056; 95% CI= 1.108, 8.427). Factors found to be significantly associated with cognitive impairment were low education level (OR=7.714; 95% CI= 2.954-20.147) and unemployment (OR= 3.299, 95% CI=1.443-7.541). Conclusion: Depression and cognitive impairment are prevalent in hemodialysis patients; they are significantly associated with high intrinsic religiosity, unmarried status, unemployment and low education level. Routine screening, multidisciplinary management and enhancing religiosity of hemodialysis patients are important preventive measures.

ABSTRACTTABLE OF CONTENTSCHAPTER I INTRODUCTION1.1 CHRONIC KIDNEY DISEASE1.2 HEMODIALYSIS1.3 DEPRESSION AND COGNITIVE IMPAIRMENT1.4 RELIGIOSITY IN DIALYSIS PATIENTS

CHAPTER II LITERATURE REVIEW2.1 CHRONIC RENAL DISEASE AND DIALYSIS2.2 DEPRESSION IN DIALYSIS PATIENTS2.3 COGNITIVE IMPAIRMENT IN DIALYSIS2.4 RELIGIOSITY AND MEDICAL ILLNESS2.5 THEORETTICAL FRAMEWORK

CHAPTER III OBJECTIVES3.1 MAIN OBJECTIVES3.2 SPECIFIC OBJECTIVE3.3 RESEARCH HYPOTHESIS3.4 SIGNIFICANCE OF THE STUDY

CHAPTER IV RESEARCH METHODOLOGY4.1 DEFINITION4.2 RESEARCH DESIGN4.3 BACKGROUND OF THE STUDY LOCATION4.4 STUDY PERIOD4.5 SAMPLE SIZE4.6 STUDY POPULATION4.7 INCLUSION CRITERIA4.8 EXCLUSION CRITERIA4.9 FLOWCHART OF METHODOLOGY (SUMMARY)4.10 INSTRUMENTS4.10.1 Socio-demographic Data Questionnaire4.10.2 Beck Depression Inventory (Validated Malay version)4.10.3 Malay version Mini International Neuropsychiatric Inventory (M.I.N.I.)4.10.4 Montreal Cognitive Assessment Bahasa Melayu (MOCA-BM)4.10.5 Validated Malay Version of Duke University religious Index (DUREL-M)

4.11 STATISTICAL ANALYSIS4.12 ETHICAL CONSIDERATION

CHAPTER V RESULTS5.1 Response Rate Of Participting Hemodialysis Patients5.2 Socio-Dermographic Features Of Participating Hemodialysis Patients5.3 PREVALENCE OF DEPRESSION, COGNITIVE IMPAIRMENT ANDRELIGIOSITY IN HEMODIALYSIS PATIENTS5.4 Factors Associated With Depression Among Hemodialysis Patients5.5 UNIVARIATE ANALYSIS VARIABLES ASSOCIATED TO DEPRESSIONIN HEMODIALYSIS5.6 MULTIVARIABLE ANALYSIS OF VARIABLES ASSOCIATED TODEPRESSION IN HEMODIALYSIS5.6.1 Variance Inflation Factor5.6.2 Goodness-of-fit assessment5.6.3 Goodness-of-fit and multivariable analysis

5.7 Factors Associated To Depression In Hemodialysis5.8 FACTORS ASSOCIATED WITH COGNITIVE IMPAIRENT AMONGHEMODIALYSIS PATIENTS5.9 UNIVARIATE ANALYSIS VARIABLES ASSOCIATED TO COGNITIVEIMPAIRMENT IN HEMODIALYSIS5.10 MULTIPLE ANALYSIS VARIABLES ASSOCIATED TO COGNITIVEIMPAIRMENT IN HEMODIALYSIS5.10.1 Goodness-of-fit assessment5.10.2 Goodness-of-fit and multivariable analysis

5.11 FACTORS ASSOCIATED TO COGNITIVE IMPAIRMENT INHEMODIALYSIS

CHAPTER VI DISCUSSION6.1 RESPONSE RATE6.2 PREVALENCE OF DEPRESSION IN HEMODIALYSIS PATIENTS6.3 THE ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS,M.I.N.I DEPRESSION, COGNITION AND RELIGIOSITY WITHDEPRESSION IN DIALYSIS PATIENTS6.4 PREVALENCE OF COGNITIVE IMPAIRMENT IN HEMODIALYSISPATIENTS6.5 THE ASSOCIATION BETWEEN SOCIO-DEMOGRAPHIC FACTORS,DEPRESSION AND RELIGIOSITY WITH COGNITIVE IMPAIRMENT INDIALYSIS PATIENTS

CHAPTER VII LIMITATIONS AND STRENGTHS7.1 LIMITATIONS7.2 STRENGTHS

CHAPTER VIII CONCLUSIONS AND RECOMMENDATIONS8.1 CONCLUSION8.2 RECOMMENDATIONS

REFERENCESAPPENDICES