Controversy exists regarding the frequency of depression in renal dialysis patients. We have assessed an unselected sample of 99 dialysis patients using the Diagnostic Interview Schedule (DIS). A current Major Depressive Episode (MDE) was diagnosed in 8.1% of the sample, one-half of whom had a past history of MDE. An additional 12.1% had only a past history of depression. In contrast to patients with no affective disorder, characteristics of patients with a current MDE included the following: a history of previous MDE; female sex; duration of dialysis less than or equal to 24 months; a younger mean age; solitary living arrangements; and unemployment. The following DSM-III criteria distinguished patients with MDE from those with no affective disorder: depressed mood or loss of interest; feelings of worthlessness or excessive guilt; anorexia and weight loss; and slowed or mixed-up thoughts. DSM-III criteria that were common in the entire sample but not useful in distinguishing patients with MDE included loss of energy, insomnia, and decreased sexual interest. These results indicate that some DSM-III criteria are common in dialysis patients and therefore do not distinguish major depression, whereas other DSM-III criteria are more specific for MDE. Further, it is possible that the prevalence of MDE is greater in dialysis patients than in the general population.

Using a novel qualitative approach, Photovoice, researchers assessed social, psychological, physical and economic barriers encountered by patients of weight loss surgery. Applying the Photovoice approach and Williams' theory of narrative reconstruction for qualitative interviewing, the research team set out to investigate the bariatric patient experience from pre-surgery to hospitalization to post-surgery. Fifteen participants were given digital cameras and asked to take photographs that represented their weight loss journeys. Photographs and qualitative interviews were used to theorize the role played by comorbidities, social determinants of health, provider communication experiences and understanding of insurance coverage in patient outcomes. Several themes emerged from the interviews and photographs including themes centred around: (i) racial/ethnic standards of beauty; (ii) gender expectations; (iii) comorbidities, depression/disordered eating and obesity discrimination and (iv) financial hardship impacting adherence. Photographs also illuminated the impact of hospital and state-wide policies on patient lives. Results suggest that Photovoice may be a useful adjunct to standard-of-care to help patients identify barriers, and to identify shortcomings in health services. Additional screening tools for gender- and income-related barriers (and concomitant referrals to support services) provide an opportunity to improve patient care and reduce post-operative readmissions.

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