Screening for depression in hemodialysis patients:: Associations with diagnosis, treatment, and outcomes in the DOPPS
Screening for depression in hemodialysis patients:: Associations with diagnosis, treatment, and outcomes in the DOPPS
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DOI：
10.1111/j.1523-1755.2004.00977.x
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发表时间：
2004-11-01
影响因子：
19.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Lopes, AA;Albert, JM;Port, FK
背景抑郁症状和抑郁是血液透析患者最常见的心理问题。我们评估了血液透析患者中抑郁症状和医生诊断的抑郁症的患病率，其在不同国家的变化，以及与抗抑郁药治疗的相关性。我们还评估了抑郁症状是否与死亡率、住院和透析退出独立相关。样本由9382名血液透析患者代表，这些患者是从参加透析结局和实践模式研究（DOPPS II）的12个国家的透析中心随机选择的。采用流行病学研究中心抑郁筛查指数（CES-D）简表，以≥ 10分为界值，对抑郁症状进行评定。经医生诊断的抑郁症总患病率为13.9%，CES-D评分≥ 10分者占43.0%。虽然在日本（2.0%）和法国（10.6%）观察到医生诊断的抑郁症患病率最低，但这些县的CES-D评分10的百分比与整个样本相似。抗抑郁药的使用也因国家而异，在医生诊断为抑郁症且CES-D评分大于或等于10分的患者中，分别有34.9%和17.3%。在校正了几种合并症的考克斯模型中，CES-D评分大于或等于10与死亡（RR=1.42; 95%CI =1.29 - 1.57）、住院（RR=1.12; 95%CI =1.03 - 1.22）和透析退出（RR=1.55; 95%CI =1.29 - 1.85）的相对风险（RR）显著升高相关。这些数据表明，血液透析患者中抑郁症的诊断和治疗不足。CES-D可以帮助识别死亡和住院风险较高的血液透析患者。干预措施应针对这些患者，以提高生存率和减少住院率。
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.