Depression as a potential explanation for gender differences in health-related quality of life among patients on maintenance hemodialysis.
OBJECTIVE
The reasons for lower health-related quality of life (HRQOL) scores in women compared to men on maintenance hemodialysis (MHD) are unknown. We investigated whether depression accounts for gender differences in HRQOL.


METHODS
Cross-sectional study of 868 (40.9% women) Brazilian MHD patients (PROHEMO Study). We used the Kidney Disease Quality of Life Short Form to assess HRQOL and the Center for Epidemiological Studies Depression (CES-D) scale (scores from 0-60) to assess depression with scores >or=18 indicating high depression probability.


RESULTS
Higher depression scores were associated with lower HRQOL in both sexes. Women had higher depression scores; 51.8% of women versus 38.2% of men (p < 0.001) had CES-D scores >or=18. Women scored lower on all 9 assessed HRQOL scales. The female-to-male differences in HRQOL were slightly reduced with inclusion of Kt/V and comorbidities in regression models. Substantial additional reductions in female-to-male differences in all HRQOL scales were observed after including depression scores in the models, by 50.9% for symptoms/problems related to renal failure, by 71.6% for mental health and by 87.1% for energy/vitality.


CONCLUSIONS
Lower HRQOL among women was largely explained by depression symptoms. Results support greater emphasis on treating depression to improve HRQOL in MHD patients, particularly women.
Lopes
Gildete Barreto
GB
Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Matos
Cácia Mendes
CM
Leite
Eneida Barreto
EB
Martins
Maria Tereza Silveira
MT
Martins
Márcia Silva
MS
Silva
Luciana Ferreira
LF
Robinson
Bruce M
BM
Port
Friedrich K
FK
James
Sherman A
SA
Lopes
Antonio Alberto
AA
D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology* / Q000706:statistics & numerical data*; D017678:Sex Distribution