**1. Introduction**

Globally, hemodialysis is one of the most common forms of renal replacement therapy for End-Stage Renal Disease (ESRD) patients. Around 69% of all kidney replacement therapies and 89% of all dialysis treatments are performed *via* hemodialysis (HD) [1, 2]. HD is performed in the center; hence, the procedure requires frequent visits to the hospital or HD centers, often three times a week for three to four hours, as a result, patients' normal living patterns are substantially altered [3, 4]. Moreover, HD treatment leads to weakness and fatigue along with the limitations of fluid and diet [5, 6]. In addition to these limitations, HD patients face social and financial challenges [7]. Hence, the logical implications of HD influence the patients' life overall and impact their quality of life [8–10].

HD patients are not the only ones affected by the magnitude of change, but also their families, as they depend largely on their families to care for them and provide them with financial support [11–14]. Even though HD treatment improved health maintenance and life extension, the quality of life of the patients is compromised by their survival treatment [15]. In a study [16], untreated depression in high prevalence among HD patients was reported and one of the main reason was the reluctance of patients toward psychotherapy.

A high proportion of patients receiving HD experience a compromised quality of life [17] and report mental health challenges due to adaptive difficulties during

disease management [15, 18, 19]. Mental and emotional distress is associated with HD due to restrictions in lifestyle, the constant threat of death, and other physical symptoms that can discourage self-management among patients [20]. According to an estimation, one in five HD patients experience depression [21, 22]. Other commonly reported symptoms are stress, anxiety, fatigue, lowered self-esteem, and social isolation [23–25]. HD patients experience anxiety, depression, and poor quality of life [26]. These mental health problems impact the response of HD patients to their treatment [27]; hence, needs attention.
