Uncovering a Silent Crisis: Psychometric Validation and Public Health Implications of Depression and Anxiety Among Caregivers of Patients Undergoing Hemodialysis in Pakistan

Background: Caregivers of patients undergoing hemodialysis face considerable psychological stress, yet culturally validated tools specific for assessing depression and anxiety in this group are lacking in Pakistan. Objective: To validate the psychometric properties of the Urdu versions of the patient health questionnaire (PHQ-9) and generalized anxiety disorder (GAD-7) scales among hemodialysis caregivers in Pakistan, to measure the prevalence of generalized anxiety disorder (GAD) and major depressive disorder (MDD), and to identify demographic and caregiving-related predictors of depression and anxiety. Methods: A cross-sectional study was conducted among 362 caregivers recruited from multiple dialysis centers across Pakistan. Participants completed the pre-validated Urdu translations of PHQ-9 and GAD-7, along with sociodemographic and caregiving-related questions. Reliability and factor structure of the screening tools were evaluated, and associations between psychological scores and caregiver characteristics were analyzed using non-parametric tests and regression models. Results: The prevalence of Major Depressive Disorder was 8.0%, and Generalized Anxiety Disorder was 18.2%. Depression correlated positively with daily caregiving hours and negatively with caregiving duration. Higher levels of depression and anxiety were observed among females, urban residents, and university-educated caregivers. Regression analysis identified caregiving intensity as a significant predictor of depression (OR = 1.101), while age, gender, residence, and caregiving duration predicted anxiety (p < 0.05). Conclusion: The Urdu versions of PHQ-9 and GAD-7 demonstrated acceptable reliability and construct validity for use among hemodialysis caregivers. The findings highlight the psychological burden within this population and support the integration of routine mental health screening and tailored interventions into dialysis care programs.