Depressive symptom severity, contributing factors, and self-management among chronic dialysis patients.
Depressive symptom severity, contributing factors, and self-management among chronic dialysis patients.
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DOI：
10.1111/hdi.12317
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Gilet CA
中科院分区：
文献类型：
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作者：
Song MK;Ward SE;Hladik GA;Bridgman JC;Gilet CA
尽管接受慢性透析的患者中抑郁症状的发生率很高，但对管理抑郁症状的与患者有关的障碍一直没有引起足够的重视，例如这些患者确定的导致其症状的因素，以及他们如何应对这些症状。参与者(N=210)正在进行一项对接受慢性透析的患者的多维生活质量的纵向观察研究，他们在12个月内每月完成一系列测量。对于每个测量点的每个患者，如果他/她在抑郁症状量表(CESD-SF≥10)上的得分超出正常范围或表现出自杀意念，则生成一份事件报告。在210名参与者中，100人(47.6%)至少有一次CESD-SF得分≥10，导致290个事件报告。在这100名参与者中，15名(15%)除了有抑郁症状外，还报告有自杀念头。最常见的致病因素包括“处理合并症和并发症”(56例，19.3%)、“正在接受透析”(50例，17.2%)、“家庭或其他个人问题”(37例，12.8%)和“经济困难”(31例，10.7%)。在11个事件报告中(3.8%)，参与者没有意识到他们的抑郁症状。在119个事件报告中(41%)，参与者报告他们与他们的透析护理提供者或初级保健提供者讨论了这些症状，而在171个事件报告中(59%)，他们没有与他们的保健提供者讨论这些症状。抑郁症状的发生率很高，许多患者缺乏有效的自我管理策略的知识。
Despite the high prevalence of depressive symptoms in patients receiving chronic dialysis, there has been inadequate attention to patient-related barriers to management of depressive symptoms, such as factors identified by these patients as contributing to their symptoms, and how they responded to the symptoms. Participants (N=210) in an ongoing longitudinal observational study of multidimensional quality of life in patients receiving chronic dialysis completed a battery of measures monthly for 12 months. For each patient at each measurement point an Event Report was generated if he/she scored outside of the normal range on the depressive symptom scale (CESD-SF ≥ 10) or expressed suicidal ideation. Of the 210 participants, 100 (47.6%) had a CESD-SF score ≥ 10 at least once resulting in 290 Event Reports. Of these 100 participants, 15 (15%) had also reported suicidal ideation in addition to having depressive symptoms. The most frequently stated contributing factors included ‘managing comorbid conditions and complications’ (56 Event Reports, 19.3%), ‘being on dialysis’ (50, 17.2%), ‘family or other personal issues’ (37, 12.8%), and ‘financial difficulties’ (31, 10.7%). On 11 Event Reports (3.8%) participants had been unaware of their depressive symptoms. On 119 Event Reports (41%) participants reported that they discussed these symptoms with their dialysis care providers or primary care providers, while on 171 Event Reports (59%) symptoms were not discussed with their healthcare providers. The prevalence of depressive symptoms is high and many patients lack knowledge about effective self-management strategies.