anxiety, assessment, chronic kidney disease, depression, dialysis, emotional distress, hemodialysis, interviews, nursing, nursing care, psychometrics, questionnaire



  1. Rodriguez-Rey, Rocio
  2. Garcia-Llana, Helena
  3. Ruiz-Alvarez, Maria Paz
  4. Gomez-Gomez, Alicia
  5. del Peso, Gloria
  6. Selgas, Rafael


Background: The Emotional State Instrument for Dialysis Patients (ES-D) is a brief semistructured questionnaire to assess emotional distress in patients undergoing dialysis. It was designed to be administered by a healthcare provider. A previous study showed preliminary indicators of its content and face validity.


Objective: The aim of the current multicenter study was to explore the ES-D's psychometric properties.


Methods: A total of 605 patients with kidney disease undergoing dialysis (524 hemodialysis and 81 peritoneal dialysis) in 19 Spanish dialysis centers completed the ES-D, along with anxiety, depression (Hospital Anxiety and Depression Scale), and resilience (Brief Resilience Scale) questionnaires. The 75 healthcare providers who performed the assessments completed a satisfaction survey.


Results: The ES-D showed adequate internal consistency ([alpha] = .73). Correlations between the ES-D scores and the scores for anxiety, depression, and resilience showed evidence of its convergent and concurrent validity. The receiver operating characteristic curve analyses showed that a cutoff of nine detected patients with moderate-to-severe emotional distress. According to these criteria, 35.4% of patients showed emotional distress. No significant differences were found between patients undergoing hemodialysis and peritoneal dialysis. The healthcare providers perceived the ES-D as useful for knowing the patients' emotional state, understanding patients' concerns, and establishing therapeutic relationships.


Conclusions: The ES-D is a useful tool for healthcare providers to explore the emotional dimension of their patients. Thus, its development represents a step forward in the improvement of comprehensive assistance and the quality of life of patients with kidney disease undergoing dialysis.