Screening for depression in hemodialysis patients:: Associations with diagnosis, treatment, and outcomes in the DOPPS

被引:231
作者
Lopes, AA
Albert, JM
Young, EW
Satayathum, S
Pisoni, RL
Andreucci, VE
Mapes, DL
Mason, NA
Fukuhara, S
Wikström, B
Saito, A
Port, FK
机构
[1] Univ Renal Res & Educ Assoc, Ann Arbor, MI 48103 USA
[2] Univ Fed Bahia, Dept Med, Salvador, Brazil
[3] Univ Michigan, Vet Adm Med Ctr, Div Nephrol, Ann Arbor, MI USA
[4] Univ Naples Federico II, Naples, Italy
[5] Amgen Inc, Thousand Oaks, CA 91320 USA
[6] Univ Michigan, Coll Pharm, Ann Arbor, MI 48109 USA
[7] Tokai Univ, Sch Med, Kanagawa 2591100, Japan
[8] Med Akad Sjukhuset, Inst Med Vetenskaper, Uppsala, Sweden
关键词
depression; dialysis; end-stage renal disease; hospitalization; mortality;
D O I
10.1111/j.1523-1755.2004.00977.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. Depressive symptoms and depression are the most frequent psychologic problems reported by hemodialysis patients. We assessed the prevalence of depressive symptoms and physician-diagnosed depression, their variations by country, and associations with treatment by antidepressants among hemodialysis patients. We also assessed whether depressive symptoms were independently associated with mortality, hospitalization, and dialysis withdrawal. Methods. The sample was represented by 9382 hemodialysis patients randomly selected from dialysis centers of 12 countries enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS II). Depressive symptoms were assessed by the short version of the Center for Epidemiological Studies Depression Screening Index (CES-D), using greater than or equal to10 CES-D score as the cut-off value. Results. Overall prevalence of physician-diagnosed depression was 13.9%, and percentage of CES-D score greater than or equal to10 43.0%. While the smallest prevalence of physician-diagnosed depression was observed in Japan (2.0%) and France (10.6%), the percentage of CES-D score 10 in these counties was similar to the whole sample. Patients on antidepressants also varied by country, 34.9% and 17.3% among those with physician-diagnosed depression and CES-D scores greater than or equal to10, respectively. In Cox models adjusted for several comorbidities, CES-D scores greater than or equal to10 were associated with significantly higher relative risks (RR) of death (RR=1.42; 95% CI=1.29 to 1.57), hospitalization (RR=1.12; 95% CI=1.03 to 1.22), and dialysis withdrawal (RR=1.55; 95% CI=1.29 to 1.85). Conclusion. The data suggest that depression is underdiagnosed and undertreated among hemodialysis patients. CES-D can help identify hemodialysis patients who are at higher risk of death and hospitalization. Interventions should target these patients with the goal to improve survival and reduce hospitalizations.
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收藏
页码:2047 / 2053
页数:7
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