title: Short-term versus long-term effects of depressive symptoms on mortality in patients on dialysis.
abstract: OBJECTIVE
  Depressive symptoms seem to pose a risk factor for mortality among patients on dialysis. It is currently unknown whether the association is only short-lived and whether associations over time depend on specific causes of mortality.
  
  
  METHODS
  In a prospective nationwide cohort study, 1528 patients with end-stage renal disease starting on dialysis completed the Mental Health Inventory. Patients were observed up to 5 years or until the end of follow-up in April 2011. Cox regression analyses were used to calculate associations between depressive symptoms and short-term (0-6 months), medium-term (6-24 months), or long-term (24-60 months) cardiovascular and noncardiovascular mortality.
  
  
  RESULTS
  The adjusted hazard ratio (HR) was 1.43 (95% confidence interval [CI] = 1.08-1.88) for cardiovascular mortality and 2.07 (95% CI = 1.62-2.64) for noncardiovascular mortality. Depressive symptoms posed a strong risk factor for noncardiovascular mortality at the short term (HR = 2.82, 95% CI = 1.58-5.05), medium term (HR = 2.08, 95% CI = 1.40-3.09), and long term (HR = 1.84, 95% CI = 1.26-2.69), whereas the association between depressive symptoms and cardiovascular mortality was not observed during the first 6 months of follow-up (HR = 1.03, 95% CI = 0.49-2.15).
  
  
  CONCLUSIONS
  Depressive symptoms at the start of dialysis therapy are associated with short-, medium-, and long-term mortality. The cause-specific mortality risk over time may help clinicians to understand multifactorial causes of the association between depressive symptoms and survival.
authors.affiliation: Department of Nephrology, Public Health and Primary Care, Leiden University Medical Center, The Netherlands. dijk@lumc.nl
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
authors.forename: Tessa O
authors.initials: TO
authors.lastname: van den Beukel
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Kaptein
authors.forename: Adriaan
authors.initials: A
authors.lastname: Honig
authors.forename: Carl E
authors.initials: CE
authors.lastname: Siegert
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: Ray T
authors.initials: RT
authors.lastname: Krediet
authors.forename: Marion
authors.initials: M
authors.lastname: Verduijn
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis; D013997:Time Factors