title: Depression, stress, and quality of life in persons with chronic kidney disease: the Heart and Soul Study.
abstract: BACKGROUND
  The effect of mild chronic kidney disease (CKD) on depression, stress, quality of life (QOL), and health status is not well understood. We compared these outcomes in subjects with and without CKD.
  
  
  METHODS
  We performed a cross-sectional study of 967 outpatients enrolled in the Heart and Soul Study. CKD was defined as a measured creatinine clearance < 60 ml/min. Outcome measures included depressive symptoms measured using the Patient Health Questionnaire (PHQ), stress measured using the Perceived Stress Scale (PSS), and QOL and overall health rated as excellent, very good, good, fair, or poor.
  
  
  RESULTS
  The prevalence of depressive symptoms (17 vs. 19%, p = 0.4) or perceived stress (11 vs. 16%, p = 0.09) did not vary significantly by CKD. The prevalence of fair or poor QOL was not significantly different in subjects with CKD, compared with those without CKD (24 vs. 23%, p = 0.65). Age-adjusted analyses revealed a significant association of CKD with QOL (p = 0.003), however, this association no longer reached statistical significance after adjustment for confounders (p = 0.06). Subjects with CKD were more likely to report poor or fair overall health than subjects without CKD (42 vs. 34%, p = 0.03). After multivariate adjustment, CKD remained significantly associated with worse overall health (OR = 1.65, 95% CI 1.21-2.24, p = 0.001), and modestly associated with QOL (OR = 1.31, 95% CI 0.99-1.75, p = 0.06), but had no association with depression (p = 0.48) or stress (p = 0.24).
  
  
  CONCLUSIONS
  In this study of persons with coronary artery disease, subjects with CKD had reduced overall health and modestly reduced QOL; however, mental health was similar in those with and without CKD. These findings suggest that self- assessed overall health may decline at earlier stages of renal dysfunction than mental health outcomes or QOL.
authors.affiliation: Section of General Internal Medicine, San Francisco VA Medical Center, San Francisco, CA 94121, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000523:psychology; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*