title: Emotional distress and health-related quality of life in patients on hemodialysis: the clinical value of COOP-WONCA charts.
abstract: BACKGROUND
  A significant percentage of patients on hemodialysis (HD) present with affective disorders such as anxiety and/or depression. The purpose of this study was to explore adaptive mixed affective disorders of patients on HD and to analyze the clinical value of a brief health-related quality-of-life (HRQoL) instrument, the COOP-WONCA charts, in our population of HD patient.
  
  
  METHODS
  Seventy-five patients (mean age 49.2 years; range 20.1-64.9), who had been on HD for a mean 110 months (range 6.1-364.5 months) were studied. The Beck Depression Inventory (BDI), Hamilton Scale of Depression (HDRS) and Hamilton Scale of Anxiety (HARS) were used. To evaluate patient HRQoL, we used the validated Spanish version of the COOP-WONCA charts.
  
  
  RESULTS
  Of the 75 patients studied, 44.0% (BDI) and 53.4% (HDRS) had some depressive symptoms which were moderate-severe in 14.7% (BDI) and in 22.7% (HDRS). Anxiety symptoms were observed in 46.6% of the patients (13.3% were of moderate-severe degree). There was a high level of association between both depression scales (BDI and HDRS) (r=0.70; p<0.001), as well as between both scales and the HARS (HDRS, r=0.82; p<0.001; BDI, r=0.53; p<0.001). The most affected dimensions of the COOP-WONCA charts were "Physical fitness" and "Overall health," whereas the least affected were "Social activities" and "Daily activities." The global score of the COOP-WONCA charts was associated with the presence of depressive (BDI, r=0.64, and HDRS, r=0.75; p<0.001) and anxiety symptoms (HARS, r=0.52; p<0.001). A score of >or= 3 corresponding to the dimension "Feelings" on the COOP-WONCA charts allowed the detection of 81.8% of the patients with clinically significant depressive symptoms (BDI >18), with a sensitivity of 96.8% and a specificity of 75% for this cutoff point.
  
  
  CONCLUSIONS
  A high percentage of patients on HD present with mixed emotional disorders (anxiety and/or depression); a good correlation is observed between HRQoL and the levels of anxiety and depression in these patients; and measuring HRQoL with the COOP-WONCA charts may help diagnose such problems.
authors.affiliation: Perpetuo Socorro Hospital, Alicante - Spain. arenasd@perpetuosocorro.nehos.com
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Arenas
authors.forename: Fernando
authors.initials: F
authors.lastname: Alvarez-Ude
authors.forename: Abilio
authors.initials: A
authors.lastname: Reig-Ferrer
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Zito
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Gil
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Carretón
authors.forename: Begoña
authors.initials: B
authors.lastname: Albiach
authors.forename: Analía
authors.initials: A
authors.lastname: Moledous
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires