Depression, alexithymia and long-term mortality in chronic hemodialysis patients.
BACKGROUND
Depression increases the risk of mortality in hemodialysis patients. Alexithymia, a disorder of affect regulation, has also been reported to be associated with mortality risk in the general population. We conducted a prospective study to estimate the independent impact of depression and alexithymia on long-term mortality.


METHODS
A total of 230 hemodialysis outpatients, with a mean age of 56.3 +/- 9.6 years, completed a batch of self-report measures including the Beck Depression Inventory-II (BDI-II), the 20-item Toronto Alexithymia Scale (TAS-20) and the 36-item Short Form Health Survey (SF-36). Survival status was confirmed every 6 months for up to 5 years. The presence of depression and alexithymia was defined by a BDI-II score of > or =14 and a TAS-20 score of > or =61, respectively.


RESULTS
During the follow-up period, 27 deaths were confirmed. Both depression and alexithymia were associated with an increased risk for all-cause mortality; the age- and sex-adjusted hazard ratio for depression was 2.36 (95% CI: 1.08-5.15; p = 0.03) and that for alexithymia was 4.29 (95% CI: 1.95-9.42; p < 0.001). Depression lost its statistical significance after controlling for alexithymia, whereas alexithymia remained significant even after adjusting for the baseline depression, health status (the summary scores of the SF-36), marital status and clinical covariates (multivariate adjusted hazard ratio = 3.62; 95% CI: 1.32-9.93; p = 0.01).


CONCLUSIONS
Alexithymia is a strong independent risk factor for all-cause mortality in hemodialysis patients.
Kojima
Masayo
M
Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. masayok@med.nagoya-cu.ac.jp
Hayano
Junichiro
J
Suzuki
Sadao
S
Seno
Hachiro
H
Kasuga
Hirotake
H
Takahashi
Hiroshi
H
Toriyama
Takanobu
T
Kawahara
Hirohisa
H
Furukawa
Toshiaki A
TA
D000342:Affective Symptoms / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D000367:Age Factors; D016009:Chi-Square Distribution; D003866:Depressive Disorder / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors