title: Depression as a potential explanation for gender differences in health-related quality of life among patients on maintenance hemodialysis.
abstract: 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.
authors.affiliation: Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
authors.forename: Gildete Barreto
authors.initials: GB
authors.lastname: Lopes
authors.forename: Cácia Mendes
authors.initials: CM
authors.lastname: Matos
authors.forename: Eneida Barreto
authors.initials: EB
authors.lastname: Leite
authors.forename: Maria Tereza Silveira
authors.initials: MT
authors.lastname: Martins
authors.forename: Márcia Silva
authors.initials: MS
authors.lastname: Martins
authors.forename: Luciana Ferreira
authors.initials: LF
authors.lastname: Silva
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Sherman A
authors.initials: SA
authors.lastname: James
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Lopes
mesh_terms: 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