Social capital and its association with clinically significant depressive symptoms in patients with end-stage kidney disease in Mexico

Abstract

Background: Patients with end-stage kidney disease (ESKD) undergoing renal replacement therapy often face significant psychological distress and depression. The social environment of these individuals may influence depressive symptoms, but research on social capital in this group is limited. This study aimed to assess the prevalence of clinically significant depressive symptoms and explore the association between different dimensions of social capital and clinically significant depressive symptoms in ESKD patients. Methods: A cross-sectional study was conducted involving 819 patients with ESKD who were undergoing peritoneal dialysis or hemodialysis at three medical facilities of the Mexican Institute of Social Security in Aguascalientes, Mexico. Data on patients’ characteristics was collected from April 2023 to January 2024. Depressive symptoms were measured on the Beck Depression Inventory II, considering a score of 17 or higher as indicative of clinically significant depressive symptoms. We utilized a validated Social Capital Questionnaire specifically designed for ESKD patients in Mexico to evaluate structural and cognitive social capital and its dimensions. Multivariable logistic regression analysis was performed to evaluate the association between social capital and clinically significant depressive symptoms. Results: The prevalence of clinically significant depressive symptoms was 27.2% (95% CI 0.24–0.30). In the structural domain of social capital, “network size” (OR 0.85; 95% CI 0.80–0.91) and “bonding within social groups” (OR 0.85; 95% CI 0.78–0.93) were associated with lower odds of clinically significant depressive symptoms, while “vertical bridging” was associated with higher odds (OR 1.06; 95% CI 1.02–1.10). In the cognitive domain, “norms of reciprocity” (OR 0.97; 95% CI 0.95–0.99), “sense of belonging” (OR 0.92; 95% CI 0.87–0.96), and “social support” (OR 0.85; 95% CI 0.80–0.90) were associated with decreased odds of clinically significant depressive symptoms, while “sense of fairness” was associated with increased odds. Conclusion: Most social capital dimensions are associated with decreased odds of clinically significant depressive symptoms in patients with ESKD. Our findings emphasize the need for strategies that enhance the protective aspects of social capital, ultimately helping to reduce the prevalence of depressive symptoms among patients with ESKD.