The diagnosis of major depression in end-stage renal disease

Background: Although major depression commonly occurs in medically ill patients, it can be difficult to diagnose since depression and many medical illnesses share common physical symptoms. Methods: This study was designed to evaluate patients with end-stage renal disease (ESRD) for major depressive disorder using three diagnostic approaches, to assess the Beck Depression Inventory as a screening instrument for major depression, and to examine the association of anhedonia with a diagnosis of major depression in ESRD patients who deny depressed mood. Results: Rates of major depression varied from 6 to 34% according to the criteria that were used. The sensitivity of the Beck Depression Inventory was found to be modest. Anhedonia was a helpful clue for diagnosing depression in patients who denied depressed mood. Conclusions:The findings illustrate the current difficulties in applying DSM criteria for major depression to medical patients and underscore the need for more specific guidelines.