The diagnosis of major depression in renal dialysis patients.

Abstract

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.

Depressed Mood, Usual Activity Level, and Continued Employment after Starting Dialysis

“…Association of depressed mood with unemployment among dialysis patients was reported Ͼ20 years ago by Craven et al (5), who assessed patients for major depressive episode using the Diagnostic Interview Schedule. Researchers who used the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (6,7) also found an association of depressed mood with unemployment among dialysis patients, and Finkelstein et al (15) noted that depressive affect (pessimism, anhedonia, sadness, complaints of feeling helpless and hopeless) may contribute to reduced occupational activity.…”

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study

“…In a study, it was reported that according to Beck Depression Inventory, 47% of the patients with ESRD have a score above the cutoff point, but major depression is diagnosed in only 5% of them as a result of structured interviews (32). In ESDR, somatic symptoms such as lack of appetite, sleep disorders, fatigue, and lack of energy, which were also reported frequently in psychiatric disorders, were commonly encountered as a result of the disease and hemodialysis, so it became particularly important to assess patients with ESRD with structured interviews (34).…”

Prevalência de transtornos psiquiátricos em pacientes em hemodiálise no estado da Bahia

“…De acordo com nossos resultados, o tempo em programa de diálise foi preditivo de melhor adaptação ao tratamento e mostrou consistência com dados da literatura, como o estudo de Craven et al (1987), que demonstrou maior prevalência de depressão em 99 indivíduos nos primeiros dois anos do tratamento. Pacientes com IRC freqüentemente experimentam melhora nas condições médicas após o início da diálise e necessitam de algum tempo para se adaptar à nova situação, demonstrando acostumar-se ao tratamento após tempo médio de um ano (Craven et al, 1987).…”

“…Pacientes com IRC freqüentemente experimentam melhora nas condições médicas após o início da diálise e necessitam de algum tempo para se adaptar à nova situação, demonstrando acostumar-se ao tratamento após tempo médio de um ano (Craven et al, 1987).…”