6 and suboptimal dialysis contributes to the risk of depression [11, 18–20]. This ﬁnding needs to be clariﬁed in further studies. None of the children with high occurrence of depressive symptomatology had a friend to conﬁde in (P = 0.03), which agrees with other studies. This conﬁrms that social support contributes to the patient’s quality of life and decreases the number of hospitalizations in children with chronic renal insuﬃciency [21]. When asked How content or happy are you with your physical appearance, studies, ﬁnancial status, and friends? ( P < 0.05), they answered “more or less (content or happy)” or “fairly (content or happy).” This conﬁrms the presence of low self-esteem related to high occurrence of depressive symptomatology, as the response “more or less” might be considered “fair” because patients tend to deny depression as a social defense [8, 10]. We know that the stress and impact of disease generate a distressing and downcast reaction and/or pain in children and their families. This is where the depressive symptoms predominate and then develop to depression or other psychi- atric changes [22]. It is for this reason that it is recommended that all children with depression, depressive symptoms, and suicidal ideation according to the Modiﬁed Birleson Scale or high and low depressive symptomatology according to the recategorization should undergo psychiatric interview to conﬁrm their probable diagnosis. As we know, depression is a clinical diagnosis and the Modiﬁed Birleson Scale gives us information about the presence of depressive symptoms, not clinical depression itself. It can be used as a tool to help us to be aware of any possible disorder, which would then need to be conﬁrmed by a psychiatrist. Future research needs to validate self-reported questionnaires in patients with chronic disease like ESRD patients. A few studies show an increased frequency of depression diagnosis after psychiatric interview compared with frequency of possible depression after self- completion of a diagnostic scale [23]. Such individuals should be candidates for treatment, since there is evidence that social, psychological, and pharmacological interventions reduce mortality, morbidity, and treatment withdrawal [24], and improve the quality of life [11, 25] associated with depression in patients with or without comorbidities [26]. Given this, diagnosis of depression should always be included in screening of pediatric patients with terminal chronic renal insuﬃciency [8]. 5. Conclusion The frequencies of high and low occurrence of depressive symptomatology were 10.45% and 43.28%, respectively. The clinical and sociodemographic factors related to high occurrence of depressive symptomatology were female sex, having or not having a friend to conﬁde in, and dialysis dose. References [1] B. J. Atencio, E. Nucette, J. 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