Abstract
Depression is more common in many medical conditions than among the general population and is associated with an increased risk of mortality. We aimed to determine whether somatic symptoms of depression were more predictive of mortality than affective and cognitive symptoms in hemodialysis patients. We conducted a prospective cohort study in which the survival outcomes of 151 subjects were followed for more than 3 years. Depression was assessed with the Taiwanese Depression Questionnaire (TDQ). Subjects with TDQ scores 19–54 (correlated with clinically significant depressive symptoms) and those with scores 15–18 had higher 3-year mortality rates than the two groups with lower scores (40.0%, 46.7%, 16.0% and 19.6%, p = 0.021, ANOVA). Affective and cognitive symptoms, including sadness, tenseness, indecisiveness and low self-confidence, and one somatic item (bodily discomfort) were associated with mortality. Affective and cognitive symptoms affected quality of life more than somatic symptoms. The somatic subscale was associated with female gender, low income and education, dialysis vintage, and low serum creatinine and albumin levels, whereas the affective and cognitive subscale was associated with less education and a low serum albumin level. In conclusion, affective and cognitive symptoms of depression may better predict long-term mortality in patients undergoing chronic hemodialysis than somatic symptoms.
Highlights
Depression is a mood disorder with a prevalence in the general population ranging from 1.6% in China1 to 5.0% in the United Kingdom2 and 9.0% in the United States3
Kimmel et al demonstrated an association between mortality and the Cognitive Depression Index (CDI), which is a 15-question subscale of the 21-question Beck Depression Inventory (BDI) that excludes items related to somatic symptoms25
Depressive symptoms are associated with higher mortality rates, lower quality of life, and low serum creatinine and serum albumin levels in patients on dialysis
Summary
Depression is a mood disorder with a prevalence in the general population ranging from 1.6% in China to 5.0% in the United Kingdom and 9.0% in the United States. Kimmel et al demonstrated an association between mortality and the Cognitive Depression Index (CDI), which is a 15-question subscale of the 21-question Beck Depression Inventory (BDI) that excludes items related to somatic symptoms. Kimmel et al demonstrated an association between mortality and the Cognitive Depression Index (CDI), which is a 15-question subscale of the 21-question Beck Depression Inventory (BDI) that excludes items related to somatic symptoms25 In another smaller series that included patients undergoing hemodialysis and peritoneal dialysis, Peterson et al showed an association between higher CDI scores and lower survival rates. To the best of our knowledge, there is no literature examining the association between somatic symptoms of depression and mortality in patients on chronic hemodialysis If such an association exists, whether somatic symptoms are a better predictor of mortality than the affective and cognitive symptoms remains to be determined. We investigated the associations between the depressive symptoms and various demographic and biochemical parameters
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