Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study.
Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study.
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DOI：
10.34067/kid.0000000000000213
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发表时间：
2023-09-01
期刊：
影响因子：
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通讯作者：
Jhamb M
中科院分区：
文献类型：
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作者：
Devaraj SM;Roumelioti ME;Yabes JG;Schopp M;Erickson S;Steel JL;Rollman BL;Weisbord SD;Unruh M;Jhamb M
较低的社区步行能力与较高的抑郁症状和疲劳以及较年轻的抑郁症状相关。抑郁症状、疼痛和疲劳经常被报告，经常一起发生，并且经常没有得到治疗。具有较高症状负担的患者和男性可能更容易寻求抑郁症状，疼痛或疲劳的治疗。血液透析（HD）患者通常会出现临床显著水平的疼痛、疲劳和抑郁症状。我们探讨了潜在的社会人口统计学差异的症状负担，目前的治疗，并准备寻求治疗这些症状的患者筛选的TSCCARE试验。对来自宾夕法尼亚州和新墨西哥州的中心内HD患者进行疲劳（0-10分Likert量表≥5分）、疼痛（Likert量表≥4分）、抑郁症状（≥10分患者健康问卷-9）和寻求治疗准备（5项行为改变阶段问卷）筛查。采用卡方检验、Fisher精确检验和logistic回归模型，对社会人口学因素引起的症状负担和治疗状态进行评估。从2018年3月至2021年12月，896例接受筛选的患者中有506例（57%）符合合格性标准并完成了症状筛选（平均年龄60±13.9岁，44%为女性，17%为黑人，25%为美洲印第安人，25%为西班牙裔）。其中，77%的患者对≥1种症状筛查呈阳性，35%的患者因≥1种症状接受治疗。疼痛、疲劳和抑郁症状的发生率分别为52%、64%和24%。年龄小于65岁与抑郁症状、疼痛和报告≥1种症状的负担较高相关（P<0.05）。准备寻求治疗的患者比例随着症状负担的增加而增加。更多的男性报告愿意寻求治疗（85%对68%的女性，P<0.001）。在那些有症状和治疗准备的人中，收入与疼痛呈负相关（> 60，000美元/年：比值比[OR]=0.16，置信区间[CI]=0.03至0.76）和居住在不太适合步行的社区，有更多的抑郁症状（OR= 5.34，CI=1.19至24.05）和疲劳（OR= 5.29，CI=1.38至20.33）。疼痛、疲劳和抑郁症状通常同时发生，年龄较小、社区步行能力较差和收入较低与HD患者的症状负担较高相关。男性患者不太可能接受症状治疗。这些发现可以为HD患者的症状识别和治疗目标提供优先信息。
Lower neighborhood walkability was associated with higher depressive symptoms and fatigue and younger age with depressive symptoms. Depressive symptoms, pain, and fatigue were frequently reported, often occurred together, and were often not all already treated. Patients with a higher symptom burden and men may be more likely to be ready to seek treatment for depressive symptoms, pain, or fatigue. Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0–10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9), and readiness to seek treatment (5–item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi square, Fisher exact tests, and logistic regression models. From March 2018 to December 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% female, 17% Black, 25% American Indian, and 25% Hispanics). Of them, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age younger than 65 years was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (P<0.05). The percentage of patients ready to seek treatment increased with symptom burden. More men reported readiness to seek treatment (85% versus 68% of women, P<0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60,000/yr: odds ratio [OR]=0.16, confidence interval [CI]=0.03 to 0.76) and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19 to 24.05) and fatigue (OR= 5.29, CI=1.38 to 20.33). Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.