The prevalence and treatment of depression among patients starting dialysis
The prevalence and treatment of depression among patients starting dialysis
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DOI：
10.1053/ajkd.2003.50029
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发表时间：
2003-01-01
影响因子：
13.2
通讯作者：
Concato, J
中科院分区：
文献类型：
--
作者：
Watnick, S;Kirwin, P;Concato, J
背景：抑郁症在终末期肾病（ESRD）患者中很常见，并与死亡率增加有关，但对刚开始透析治疗的患者的抑郁症知之甚少。我们试图评估开始透析治疗的ESRD患者抑郁症状的患病率，确定与抑郁相关的患者特征，并确定患有严重抑郁症状的患者是否正在接受治疗。方法：我们在康涅狄格州的14个透析中心实施了一项多中心前瞻性队列研究。在2000年11月至2001年7月期间，18岁及以上的ESRD患者在开始透析治疗的10天内接受了采访。采用贝克抑郁量表（BDI）评估抑郁症状。卡方检验用于评估患者的一些特征与抑郁症之间的关联，多变量逻辑回归模型用于确定抑郁症的优势比（ORs），并对基线变量进行调整。结果：在123例患者中，44%（123例患者中的54例）的抑郁BDI得分高于有效的临界值。在logistic回归分析中，抑郁症与高加索人种（OR, 3.4; P = 0.02）、较低的自评生活质量（OR, 2.2; P = 0.003）、以前没有接受透析治疗的熟人（OR, 10.2; P = 0.03）相关，具有统计学意义。只有16%（54名患者中的9名）的抑郁症患者在入组时接受了治疗；症状较轻的患者中有13%（38例患者中有5例）和症状较重的患者中有25%（16例患者中有4例）正在接受治疗。结论：我们的研究结果表明，抑郁症状在透析治疗开始时非常常见，并且特定的特征与更大的抑郁症状负担相关。尽管发病率很高，但治愈率很低，即使在中度至重度抑郁症患者中也是如此。
Background: Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality, but little is known about depression in patients just after they start dialysis therapy. We sought to assess the prevalence of depressive symptoms in patients with ESRD starting dialysis therapy, identify patient characteristics associated with depression, and determine whether patients with serious depressive symptoms were receiving treatment. Methods: We implemented a multicenter prospective cohort study at 14 dialysis centers in Connecticut. Patients with ESRD who were 18 years and older were interviewed within 10 days of initiating dialysis therapy between November 2000 and July 2001. The Beck Depression Inventory (BDI) was used to assess depressive symptoms. Chi-square tests were used to evaluate associations between several patient characteristics and depression, and multivariable logistic regression models were used to determine odds ratios (ORs) for depression, with adjustment for baseline variables. Results: Among 123 patients, 44% (54 of 123 patients) had scores above the validated cutoff value in the BDI for depression. In logistic regression analysis, depression was statistically significantly associated with Caucasian race (OR, 3.4; P = 0.02), lower self-rated quality of life (OR, 2.2; P = 0.003), and no previous acquaintances on dialysis therapy (OR, 10.2; P = 0.03). Only 16% (9 of 54 patients) of depressed patients were being treated at enrollment; 13% (5 of 38 patients) of those with mild symptoms and 25% (4 of 16 patients) with more severe symptoms were being treated. Conclusion: Our results show that depressive symptoms are very common at the start of dialysis therapy, and specific characteristics are associated with a greater burden of depressive symptoms. Despite a high prevalence, treatment rates are low, even among patients with moderate to severe symptoms of depression.