Underdiagnosis of Major Depressive Episodes in Hemodialysis Patients: The Need for Screening and Patient Education.

Wojciech Orzechowski,Dorota Daniewska,Bartosz Fiderkiewicz,Ryszard Gellert,Paweł Żebrowski,Joanna Emma Szczerba,Wiktor Buczek,Andrzej Kokoszka,Andrzej Rydzewski

doi:10.3390/jcm10184109

Abstract

This article aims to identify the reasons why patients with major depressive episode (MDE) do not seek treatment for their mental disorder. 89 out of 208 persons screened were diagnosed with major depressive episode using the Mini-International Neuropsychiatric Interview. 85 individuals with untreated depression filled out the following questionnaires: Beck Depression Inventory, List of Explanations of Well-Being (LEWB), Brief Measure to Assess Perception of Self-Influence on the Course of the Disease, Coping Inventory for Stressful Situations, Brief Method of Evaluating Coping with Disease, and Metacognitions Questionnaire. There were 43 women (50.6%) and 42 men (49.4%), aged 24 to 93 years (Mean (M) = 68.26 years; Standard Deviation (SD) = 14.19 years), with dialysis vintage ranging from 1 month to 33 years (M = 70.63 months; SD = 75.26 months). Among study patients, 70.6% declared that depression was the cause of their poor well-being, 75.3% attributed their depressive symptoms to kidney failure, and 49.4%, more specifically, to hemodialysis. A total of 64.7% of patients had a low perception of self-influence on the course of their kidney disease, and 58.5% presented a coping style focused on emotions. The most frequent dysfunctional metacognitive beliefs were negative beliefs about not controlling one’s own thoughts. This attitude was related to the low perception of self-influence on the course of the disease, maladaptive coping styles, and dysfunctional metacognitive beliefs.

Highlights

A total of 123 hemodialysis patients participated in the pilot study in Warsaw; 23 individuals (18.47%) from this group withdrew from the study
Patients’ responses to List of Explanations of Well-Being (LEWB) (Table 2) indicated that the vast majority of those with undiagnosed and untreated Major depressive disorder (MDD) had not taken into consideration the fact that they were suffering from a mental disorder
That about half of the patients definitely did not associate their depressive state with chronic kidney disease or dialysis treatment

Summary

Introduction

Major depressive disorder (MDD) is a seriously disabling disease that in 2007 became the third leading cause of years of healthy life lost due to disability (YLDs) in all age groups [1]. In a recent study by Kokoszka et al [4], depressive disorders were diagnosed with the use of the structured Mini-International Neuropsychiatric Interview (MINI) 5.0.0 [5,6] in 78.5% of 84 hemodialysis patients, including 29.0% with major depressive episode (MDE). The prevalence of depression in hemodialysis patients is higher (52%) than in those with other chronic diseases (42%) and those without chronic diseases (10%) [7]. Depression in patients receiving dialysis leads to increased mortality [8], longer hospitalization time [9], longer hemodialysis vintage, and less frequent transplants [10]

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