Course of Depression and Anxiety Diagnosis in Patients Treated with Hemodialysis: A 16-month Follow-up
Course of Depression and Anxiety Diagnosis in Patients Treated with Hemodialysis: A 16-month Follow-up
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DOI：
10.2215/cjn.01120308
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发表时间：
2008-11-01
影响因子：
9.8
通讯作者：
Kimmel, Paul L.
中科院分区：
文献类型：
--
作者：
Cukor, Daniel;Coplan, Jeremy;Kimmel, Paul L.
背景和目标：人们越来越认识到需要认真研究接受血液透析治疗的终末期肾病患者的精神表现。本研究报告了抑郁症和焦虑症的诊断过程及其对生活质量和健康状况的影响。设计、背景、参与者和测量：通过结构化临床访谈测量了 50 名接受血液透析治疗的终末期肾病患者的 16 个月精神病诊断过程。结果：确定了三种不同的途径：一部分患者在基线或 16 个月随访时没有精神病诊断（68% 为抑郁症，51% 为抑郁症）。一组为间歇性病程（21% 为抑郁症，34% 为焦虑症），一组为持续性病程（11% 为抑郁症，15% 为焦虑症），在时间 I 和时间 2 均得到诊断。对于抑郁症，与非抑郁和间歇性抑郁人群相比，持续性病程的人表现出生活质量和自我报告的健康状况显着下降。时间 2 时抑郁情绪最有力的预测因子是时间 1 时的抑郁情绪程度（P < 0.05）。结论：即使在单个时间点，也可以通过高水平的抑郁情绪来潜在地识别出处于短期和长期抑郁并发症风险的患者。由于近 20% 的样本患有慢性抑郁或焦虑，因此对血液透析患者进行精神诊断并提供治疗非常重要，因为如果不进行干预，精神疾病可能会在相当大比例的患者中持续存在。
Background and objectives: There is growing identification of the need to seriously study the psychiatric presentations of end-stage renal disease patients treated with hemodialysis. This study reports on the course of depression and anxiety diagnoses and their impact on quality of life and health status.Design, setting, participants, & measurements: The 16-mo course of psychiatric diagnoses in 50 end-stage renal disease patients treated with hemodialysis was measured by structured clinical interview.Results: Three different pathways were identified: one subset of patients not having a psychiatric diagnosis at either baseline or 16-mo follow-up (68% for depression, 51% for anxiety), one group having an intermittent course (21% for depression, 34o% for anxiety), and one group having a persistent course (11% for depression, 15% for anxiety), with diagnoses at both time I and time 2. For depression, the people with the persistent course showed marked decreases in quality of life and self-reported health status compared with the nondepressed and intermittently depressed cohorts. The most powerful predictor of depression at time 2 is degree of depressive affect at time 1(P < 0.05).Conclusions: Patients at risk for short- and long-term complications of depression can be potentially identified by high levels of depressive affect even at a single time point. As nearly 20% of the sample had chronic depression or anxiety, identifying a psychiatric diagnosis in hemodialysis patients and then offering treatment are important because, in the absence of intervention, psychiatric disorders are likely to persist in a substantial proportion of patients.