title: Acceptance of Antidepressant Treatment by Patients on Hemodialysis and Their Renal Providers.
abstract: Depression is common in patients receiving chronic hemodialysis but seems to be ineffectively treated. We investigated the acceptance of antidepressant treatment by patients on chronic hemodialysis and their renal providers.
  
  
  
  As part of a clinical trial of symptom management in patients on chronic hemodialysis conducted from 2009 to 2011, we assessed depression monthly using the Patient Health Questionnaire 9. For depressed patients (Patient Health Questionnaire 9 score ≥10), trained nurses generated treatment recommendations and helped implement therapy if patients and providers accepted the recommendations. We assessed patients' acceptance of recommendations, reasons for refusal, and provider willingness to implement antidepressant therapy. We analyzed data at the level of the monthly assessment.
  
  
  
  Of 101 patients followed for ≤12 months, 39 met criteria for depression (Patient Health Questionnaire 9 score ≥10 on one or more assessments). These 39 patients had depression on 147 of 373 (39%) monthly assessments. At 103 of these 147 (70%) assessments, patients were receiving antidepressant therapy, and at 51 of 70 (70%) assessments, patients did not accept nurses' recommendations to intensify treatment. At 44 assessments, patients with depression were not receiving antidepressant therapy, and in 40 (91%) instances, they did not accept recommendations to start treatment. The primary reason that patients refused the recommendations was attribution of their depression to an acute event, chronic illness, or dialysis (57%). In 11 of 18 (61%) instances in which patients accepted the recommendation, renal providers were unwilling to provide treatment.
  
  
  
  Patients on chronic hemodialysis with depression are frequently not interested in modifying or initiating antidepressant treatment, commonly attributing their depression to a recent acute event, chronic illness, or dialysis. Renal providers are often unwilling to modify or initiate antidepressant therapy. Future efforts to improve depression management will need to address these patient- and provider-level obstacles to providing such care.
authors.affiliation: Renal-Electrolyte Division, Department of Medicine and.
authors.forename: Julio E
authors.initials: JE
authors.lastname: Pena-Polanco
authors.affiliation: Center for Health Equity Research and Promotion and.|Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.affiliation: Renal-Electrolyte Division, Department of Medicine and.
authors.forename: Fadi A
authors.initials: FA
authors.lastname: Tohme
authors.affiliation: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Center for Health Equity Research and Promotion and.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.affiliation: Renal-Electrolyte Division, Department of Medicine and.|Renal Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Palevsky
authors.affiliation: Renal-Electrolyte Division, Department of Medicine and.|Center for Health Equity Research and Promotion and.|Renal Section, Medicine Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Weisbord
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D016079:Refusal to Treat; D006435:Renal Dialysis / Q000451:nursing / Q000523:psychology; D016312:Treatment Refusal
chemical_list: D000928:Antidepressive Agents
keywords: Chronic Disease; Depressive Disorder; Disease Management; Fluid Therapy; Humans; Nurses; Surveys and Questionnaires; acceptance; anti-depressant therapy; depression; hemodialysis; psychological; quality of life; renal dialysis; symptoms; treatment