Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS.
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 > or =10 CES-D score as the cut-off value.


RESULTS
Overall prevalence of physician-diagnosed depression was 13.9%, and percentage of CES-D score > or =10 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 > or =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 > or =10, respectively. In Cox models adjusted for several comorbidities, CES-D scores > or =10 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).


CONCLUSIONS
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.
Lopes
Antonio Alberto
AA
Department of Medicine, Federal University of Bahia, Brazil.
Albert
Justin M
JM
Young
Eric W
EW
Satayathum
Sudtida
S
Pisoni
Ronald L
RL
Andreucci
Vittorio E
VE
Mapes
Donna L
DL
Mason
Nancy A
NA
Fukuhara
Shunichi
S
Wikström
Björn
B
Saito
Akira
A
Port
Friedrich K
FK
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D006435:Renal Dialysis / Q000523:psychology*; D016896:Treatment Outcome
D000928:Antidepressive Agents