title: The association of mental health over time with cardiac outcomes in HEMO study patients.
abstract: OBJECTIVE
  Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality.
  
  
  METHODS
  This study examined the association of changes in mental health over time with all-cause and cause-specific deaths and cardiac hospitalizations in the Hemodialysis study patients. Mental health was assessed at baseline and annually during the study with short form 36 mental health index scores. Poorer mental health was defined by a mental health index score≤60.
  
  
  RESULTS
  Patients with poorer mental health at baseline were more likely to have less than a high school education and be unmarried, have significantly higher index of coexistent disease scores, and report taking β-blockers and sleep medications. Low mental health scores over time were independently associated with a decrease in survival time from all-cause mortality by -0.06 (-0.10, -0.03; P<0.001), and they also significantly hastened time to first cardiac hospitalization by -0.08 (-0.13, -0.02; P=0.01) and composite of first cardiac hospitalization or cardiac death by -0.04 (-0.07, -0.02; P<0.001).
  
  
  CONCLUSIONS
  This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention to mental health related to cardiac complications and even death in dialysis patients.
authors.affiliation: Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Ea Wha
authors.initials: EW
authors.lastname: Kang
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Sarah
authors.initials: S
authors.lastname: Ramer
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdel-Kader
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States