title: Screening for depression in hemodialysis patients: associations with diagnosis, treatment, and outcomes in the DOPPS.
abstract: 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.
authors.affiliation: Department of Medicine, Federal University of Bahia, Brazil.
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Lopes
authors.forename: Justin M
authors.initials: JM
authors.lastname: Albert
authors.forename: Eric W
authors.initials: EW
authors.lastname: Young
authors.forename: Sudtida
authors.initials: S
authors.lastname: Satayathum
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Vittorio E
authors.initials: VE
authors.lastname: Andreucci
authors.forename: Donna L
authors.initials: DL
authors.lastname: Mapes
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Mason
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Björn
authors.initials: B
authors.lastname: Wikström
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents