Self-Efficacy, Social Support, and Depression: Mediators of Medication Adherence in Dialysis Patients

Introduction: Healthcare providers' understanding of how self-efficacy and social support affect medication adherence and depression in dialysis patients can lead to holistic interventions and improve outcomes. This study aimed to investigate how self-efficacy and social support indirectly influence the relationship between medication adherence and depressive symptoms in patients with chronic kidney disease (CKD) undergoing dialysis. Methods: We employed a cross-sectional observational study design with 668 CKD patients from outpatient departments (OPDs) and dialysis centers in the Hail region of Saudi Arabia. The data were collected between April and May 2024. Results: The participants had a relatively high level of self-efficacy (median = 82.00/100) and greater perception of social support (median = 75.500/84) with minimal to mild depressive symptoms (median = 15.00/63); however, 50% of participants scored ≥ 5 (out of 10) on the level of adherence to their medication regimen. Depression was prevalent, with a mean score of 5.03 on the PHQ-9 scale, and was positively correlated with nonadherence. Social support and self-efficacy were negatively correlated with depression, and both partially mediated the link between depression and non-adherence. Conclusions: This study found that, despite high social support and self-efficacy, a significant number of patients with CKD on dialysis exhibited medication non-adherence. Depression has emerged as a key factor influencing adherence, even in the presence of social support and self-efficacy. These findings suggest that depression is crucial for CKD management. Healthcare providers, owing to their frequent interactions with patients with CKD, are ideally placed to screen for depression and incorporate management strategies into patient care plans. By addressing both the biological and psychological aspects of CKD, they can empower patients to take a more active role in their treatment, ultimately leading to improved health outcomes.