Tesis

Penapisan Gejala Kecemasan dan Depresi pada Anak dengan Penyakit Ginjal Kronik Menggunakan Kortisol sebagai Biomarker dibandingkan dengan Kuesioner Children Depression Inventory (CDI) dan Screen for Anxiety and Related Disorders (SCARED) = Screening for Anxiety and Depression Symptoms in Children with Chronic Kidney Disease (Cortisol as a Biomarker and Screen for Anxiety and Related Disorders, Children Depression Inventory Questionnaire).

Latar belakang: Anak dengan penyakit ginjal kronik (PGK) memiliki tantangan risiko gangguan cemas dan depresi yang besar karena stres fisis dan psikologis yang dialami. Kadar kortisol meningkat pada kondisi stres. Gangguan cemas dan depresi sulit dikenali sehingga memerlukan penilaian yang baik dari klinisi melalui kuesioner dan wawancara terpimpin. Tujuan penelitian ini adalah menilai hubungan kortisol saliva dengan gejala kecemasan dan depresi pada anak dengan PGK. Metode: Penelitian potong lintang ini melibatkan 91 anak dan remaja usia 8- 18 tahun dengan PGK di Rumah Sakit Cipto Mangunkusumo (RSCM). Gangguan psikososial melalui pengisian kuesioner children depression inventory (CDI) dan screen for anxiety and related disorders (SCARED). Kadar kortisol saliva diperiksa melalui pemeriksaan ELISA. Analisis kadar kortisol saliva dengan skor CDI dan SCARED dibuat untuk mengetahui hubungan hormon stres dengan gejala kecemasan dan depresi. Hasil: Prevalens gejala kecemasan pada stadium 1-3 sebesar 38,6% dan stadium 4-5 sebesar 40,4%. Prevalens gejala depresi pada stadium 1-3 sebesar 29,5% dan stadium 4-5 sebesar 38,3%. Median kadar kortisol pada anak dengan PGK yang mengalami gejala depresi 4,48 (0,48-21,83) µg/dL tidak bermakna secara statistik dibandingkan yang tidak mengalami gejala depresi 3,85 (0,52-10,82) µg/dL. Median kadar kortisol pada anak dengan PGK yang mengalami gejala kecemasan 4,57 (0,48-21,83) µg/dL tidak bermakna secara statistik dibandingkan yang tidak mengalami gejala kecemasan 3,87(0,52-10,82) µg/dL. Median kortisol pada stadium 1-3 dan stadium 4-5 terhadap CDI tidak bermakna secara statistik. Median kortisol pada stadium 1-3 terhadap SCARED tidak bermakna secara stastistik, tetapi bermakna pada stadium 4-5 dengan p=0,034. Kesimpulan: Prevalens gejala kecemasan pada stadium 1-3 sebesar 38,6% dan stadium 4-5 sebesar 40,4%. Prevalens gejala depresi pada stadium 1-3 sebesar 29,5% dan stadium 4-5 sebesar 38,3%. Kortisol saliva PGK stadium 1-3 dan 4-5 tidak ada perbedaan bermakna antara yang mengalami gejala depresi dan tidak. Kortisol saliva PGK stadium 1-3 tidak ada perbedaan bermakna yang mengalami gejala kecemasan dan tidak. Kortisol saliva pada PGK stadium 4-5 terdapat perbedaan bermakna antara yang mengalami gejala kecemasan dan tidak.
Kata kunci: cemas, depresi, kortisol, anak dengan penyakit ginjal kronik


Background: Children with chronic kidney disease (CKD) have a higher risk of anxiety and depression due to the physical and psychological stress they experience. Cortisol levels increase under stressful conditions. Anxiety and depression disorders are difficult to recognize and therefore require good assessment from clinicians through questionnaires and guided interviews. Methods: This cross-sectional study involved 91 children and adolescents aged 8-18 years with CKD at Cipto Mangunkusumo Hospital (RSCM). Psychosocial disorders through filling out the children depression inventory (CDI) and screen for anxiety and related disorders (SCARED) questionnaires. Salivary cortisol levels were checked via ELISA examination. Analysis of cortisol levels with CDI and SCARED scores was made to analyze the relationship between stress hormones and anxiety and depression symptoms. Results: The prevalence ofanxiety symptoms in stages 1-3 was 38.6% and stages 4-5 was 40.4%. Prevalence ofdepressive symptoms in stages 1-3 was 29.4% and stages 4- 5 was 38.3%. Median cortisol level in children with CKD who experienced depression symptoms was 4.48 (0.48-21.83) µg/dL which was not statistically significant compared to 3.85 (0.52-10.82) µg/dL for those who did not experience depression symptoms. Median cortisol level in children with CKD who experienced anxiety symptoms was 4.57 (0.48-21.83) µg/dL which was not statistically significant compared to 3.87 (0.52-10.82) µg/dL for those who did not experience anxiety sympstoms. Median cortisol at stages 1-3 and stages 4-5 for CDI was not statistically significant. Median cortisol at stages 1-3 of SCARED was not statistically significant, but was significant at stages 4-5 with p=0.034. Conclusion: The prevalence ofanxiety symptoms in stages 1-3 was 38.6% and stages 4-5 was 40.4%. Prevalence of depressive symptoms in stages 1-3 was 29.4% and stages 4-5 was 38.3%. There was no significant difference between salivary cortisol of CKD stages 1-3 and 4-5 who experienced depression symptoms and those who did not. There is no significant difference between salivary cortisol of stage 1-3 CKD who experienced anxiety symptoms and those who did not, but there is a significant difference in stage 4-5 CKD who experienced anxiety symptoms and those who did not.
Key words: anxiety, cortisol, depression, CKiD