Associations among Spirituality, Health-Related Quality of Life, and Depression in Pre-Dialysis Chronic Kidney Disease Patients: An Exploratory Analysis in Thai Buddhist Patients

There are numerous studies of quality of life (QOL) in chronic kidney disease (CKD) patients; however, there are a few studies of spirituality and its association with QOL. Previous studies were done focusing on Western cultures; thus, the study of CKD patients in Eastern cultures would reveal interesting insights. This study was conducted to explore the spirituality, QOL, and depression of Thai CKD patients, and the associations between spirituality, QOL, and depression. This cross-sectional descriptive study using structured questionnaires was approved by the Khon Kaen University Ethics Committee in Human Research, Thailand. A total of 63 pre-dialysis CKD stage V patients who visited the kidney diseases clinic as appointed at the outpatient department in a community hospital in northeastern Thailand were recruited. The patients were asked for consent and then interviewed. Spirituality was assessed by using the WHOQOL Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). The 9-item Thai Health Status Assessment Instrument (9-THAI) was used to assess QOL. The Beck Depression Inventory-II (BDI-II) was used to evaluate the depression. The study patients had high WHOQOL-SRPB and FACIT-Sp spirituality scores (median = 18.0, and 44.0, respectively). The 9-THAI QOL scores were within the normal range of the Thai general, healthy population (physical health score [PHS]; median = 48.0, mental health score [MHS]; median = 32.0). Based on BDI-II scores, most patients were in the minimal depression group (63.5%). The Spearman rho correlation coefficients (rs) of PHS and WHOQOL-SRPB and FACIT-Sp were moderate with 0.34 for both spirituality measures. Similarly, also the mental health scores (MHS) correlated moderately with WHOQOL-SRPB (rs = 0.46) and FACIT-Sp (rs = 0.37). Depressive symptoms (BDI-II) strongly negatively correlated with WHOQOL-SRPB (rs = −0.58) and FACIT-Sp (rs = −0.55). Overall results were consistent with previous studies in Western contexts. Understanding spirituality would lead to the better management of depression and improving patient survival. These significant associations suggest that further research is needed on how provider knowledge of patient spirituality could affect the outcomes for patients both in terms of depression and patient survival