1
|
Ko T, Kaneko H, Suzuki Y, Okada A, Azegami T, Fujiu K, Takeda N, Morita H, Yokoo T, Hayashi K, Komuro I, Yasunaga H, Nangaku M, Takeda N. Dose-dependent association between estimated glomerular filtration rate and the subsequent risk of depression: An analysis of a nationwide epidemiological dataset. Eur J Clin Invest 2024:e14322. [PMID: 39334519 DOI: 10.1111/eci.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Although the risk of depression is well-known in the patients with kidney dysfunction, especially at the late stages, little is known about the exact point at which the decline in estimated glomerular filtration rate (eGFR) begins to significantly increase the risk of depression. In the present study, we analysed a nationwide epidemiological dataset to investigate the dose-dependent association between baseline eGFR and a future risk of developing depression in a general population. METHODS We retrospectively analysed 1,518,885 individuals (male: 46.3%) without a history of depression identified between April 2014 and November 2022 within a nationwide epidemiological database, provided by DeSC Healthcare (Tokyo, Japan). We investigated the association of eGFR with the incidence of depression using Cox regression analyses and also conducted cubic spline analysis to investigate the dose-dependent association between eGFR and depression. RESULTS In the mean follow-up of 1218 ± 693 days, 45,878 cases (3.0% for total participants, 2.6% for men and 3.3% for women) of depression were recorded. The risk of depression increased with the eGFR decline as well as the presence of proteinuria. Multivariable Cox regression analysis showed the hazard ratio (95% CI) of depression in each kidney function category (eGFR ≥90, 60-89, 45-59, 30-44, 15-29, and < 15 mL/min/1.73 m2) was 1.14 (1.11-1.17), 1 (reference), 1.11 (1.08-1.14), 1.51 (1.43-1.59), 1.77 (1.57-1.99) and 1.77 (1.26-2.50), respectively. In the cubic spline analysis, the risk of depression continued to increase monotonically as the eGFR declined when the eGFR fell below approximately 65 mL/min/1.73 m2. CONCLUSIONS Our analysis using a large-scale epidemiological dataset presented the dose-dependent association between eGFR decline and the risk of depression, which highlights the importance of incorporating mental health assessments into the routine care of patients with kidney dysfunction, regardless of the stage of their disease.
Collapse
Grants
- Sakakibara Heart Foundation Cardiovascular Research Program 2023
- Japanese Circulation Society
- 23AA2003 Ministry of Health, Labour and Welfare
- Japan Foundation for Applied Enzymology
- JP23ek0109600h0003 AMED
- 22K21133 Ministry of Education, Culture, Sports, Science and Technology
- 20H03907 Ministry of Education, Culture, Sports, Science and Technology
- 21H03159 Ministry of Education, Culture, Sports, Science and Technology
- 21K08123 Ministry of Education, Culture, Sports, Science and Technology
- Takeda Science Foundation
- Japan Heart Foundation
Collapse
Affiliation(s)
- Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Azegami
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Issei Komuro
- International University of Health and Welfare, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
2
|
Wu YY, Gao YY, Wang JQ, Zhang C, Xu PJ, Liu J, Yu RZ, Zhang HJ. The influence of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life of patients with sarcopenia receiving haemodialysis: a randomised controlled trial. BMC Complement Med Ther 2024; 24:194. [PMID: 38760722 PMCID: PMC11100145 DOI: 10.1186/s12906-024-04485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To study the effect of mindfulness meditation combined with progressive muscle relaxation training on the clinical efficacy and quality of life in patients with sarcopenia receiving maintenance haemodialysis (MHD). METHODS Eligible patients with sarcopenia in our hospital were randomly assigned to a control group (n = 24) and an intervention group (n = 25). The control group received conventional dialysis treatment, while the intervention group underwent mindfulness meditation combined with progressive muscle relaxation training during the interdialysis period in addition to conventional dialysis treatment. The effect of the intervention was evaluated after 12 weeks. RESULTS There were no significant differences in the baseline values of various parameters between the two groups. Exercise capacity (sit-to-stand test,handgrip,time to 10 sit-ups) significantly improved in the intervention group after 12 weeks (32.68 ± 8.32 vs 26.50 ± 6.83; 37.42 ± 10.12 vs 28.12 ± 8.51; 19.8 ± 5.40 vs 25.29 ± 7.18) (p < 0.05). In terms of the kidney disease quality of life (KDQOLTM) score, all other dimensions except sexual function, social functioning, burden of kidney disease and work status dimensions showed significant improvement compared to the baseline (p < 0.05). In the control group, only the dialysis staff encouragement (DSE) and patient satisfaction (PS) dimensions showed slight improvements compared to the baseline (p > 0.05). When compared with the control group, the intervention group showed significant improvements in 10 dimensions of exercise capacity and KDQOLTM scores for physical function, role-physical, general health, energy, symptom/problem list, sleep, DSE, pain, cognitive function, emotional well-being and patient PS after 12 weeks (61.30 ± 5.38 vs 42.98 ± 5.73; 57.50 ± 3.55 vs 50.70 ± 3.62) (p < 0.05). Some inflammatory markers, such as the levels of interleukin-6 and high-sensitivity C-reactive protein (30.29 ± 2.96 vs 17.65 ± 3.22; 8.93 ± 0.99 vs 3.02 ± 0.34), showed a decrease during the intervention, while albumin and prealbumin levels were significantly increased compared with the baseline (30.62 ± 1.65 vs 35.60 ± 1.68; 0.32 ± 0.05 vs 0.44 ± 0.07) (p < 0.05). CONCLUSION Combined intervention training can improve the motor ability and quality of life of patients with sarcopenia within a short period of time.
Collapse
Affiliation(s)
- Yong-Yao Wu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Yi-Yi Gao
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Jing-Qiao Wang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Chao Zhang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Peng-Jie Xu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Jiang Liu
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China
| | - Ri-Zhen Yu
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
| | - Hao-Jie Zhang
- Department of Nephrology, Ningbo Medical Center Lihuili Hospital, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315099, Zhejiang, China.
| |
Collapse
|
3
|
Razzera BN, Adamoli AN, Ranheiri MF, Oliveira MDS, Feoli AMP. Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review. ACTA ACUST UNITED AC 2021; 44:84-96. [PMID: 34643641 PMCID: PMC8943880 DOI: 10.1590/2175-8239-jbn-2021-0116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies. METHODS We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936). RESULTS Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1). CONCLUSIONS MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.
Collapse
Affiliation(s)
- Bruno Nunes Razzera
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Angélica Nickel Adamoli
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Serviço de Educação Física e Terapia Ocupacional de Nefrologia, Porto Alegre, RS, Brasil
| | - Maitê Freitas Ranheiri
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Margareth da Silva Oliveira
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| | - Ana Maria Pandolfo Feoli
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde e da Vida, Programa de Pós-Graduação em Psicologia, Porto Alegre, RS, Brasil
| |
Collapse
|
4
|
Gabbard J, McLouth CJ, Brenes G, Claudel S, Ongchuan S, Burkart J, Pajewski N, Callahan KE, Williamson JD, Murea M. Rapid Electronic Capturing of Patient-Reported Outcome Measures in Older Adults With End-Stage Renal Disease: A Feasibility Study. Am J Hosp Palliat Care 2021; 38:432-440. [PMID: 32935548 PMCID: PMC8216503 DOI: 10.1177/1049909120954805] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) have a high burden of physical and psychological symptoms. Many remain unrecognized for long periods of time, particularly in older adults. The best strategy to monitor patient-reported outcome measures (PROMs) has not been identified. OBJECTIVE To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD). METHODS We designed an iPad application-delivery system for collecting electronic PROMs (ePROMs). Patient's ≥60 years of age with ESRD on HD were recruited from a single outpatient dialysis unit. Feasibility was evaluated based on recruitment, retention, and the system usability score (SUS). Assessments were completed at baseline, 3 months, and 6 months after enrollment. ANOVA was used to assess longitudinal symptom variability. RESULTS Twenty-two patients (49% recruitment rate) were enrolled, with an 82% retention at 6 months. Mean age was 69.4 years (SD 6.6), 63.6% were female, and 81.8% were African American. Participants reported minimal difficulty in using the app, with an overall SUS score of 77.6. There were no significant relationships between demographic characteristics (age, race, or education) and SUS. Baseline SF-12 physical score and SF-12 mental score were 40.4 (SD 9.1) and 33.9 (SD 6.7), respectively. No significant changes were seen in longitudinal ePROMs of pain, depression, or anxiety; but was seen in the dialysis symptom index. CONCLUSION In older patients with ESRD, collection of iPad-based ePROMs is feasible. This process can overcome inefficiencies associated with paper questionnaires and enable systematic monitoring of symptom burden.
Collapse
Affiliation(s)
- Jennifer Gabbard
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher J. McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Gretchen Brenes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sophie Claudel
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha Ongchuan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John Burkart
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas Pajewski
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E. Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Health Care Innovation, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mariana Murea
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
5
|
Skoumalova I, Geckova AM, Rosenberger J, Majernikova M, Kolarcik P, Klein D, de Winter AF, van Dijk JP, Reijneveld SA. Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7913. [PMID: 33126638 PMCID: PMC7663113 DOI: 10.3390/ijerph17217913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21-3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26-2.98) or anxiety (OR/95% CI: 1.81/1.22-2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients' psychological distress to ensure adequate adherence with recommended diet.
Collapse
Affiliation(s)
- Ivana Skoumalova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia;
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia;
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Jaroslav Rosenberger
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia;
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 01 Kosice, Slovakia;
- 2nd Department of Internal Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia
| | - Maria Majernikova
- FMC-Dialysis Services Slovakia, Trieda SNP 1, 040 01 Kosice, Slovakia;
| | - Peter Kolarcik
- Department of Health Psychology and Research Methodology, Faculty of Medicine, P.J. Safarik University, Trieda SNP 1, 040 01 Kosice, Slovakia; (A.M.G.); (J.R.); (P.K.)
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia;
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Daniel Klein
- Institute of Mathematics, Faculty of Science, P. J. Safarik University, Jesenna 5, 040 01 Kosice, Slovakia;
| | - Andrea F. de Winter
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
| | - Jitse P. van Dijk
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P.J. Safarik University in Kosice, Trieda SNP 1, 040 01 Kosice, Slovakia;
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
- Olomouc University Social Health Institute, Palacky University, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Sijmen A. Reijneveld
- Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands; (A.F.d.W.); (S.A.R.)
| |
Collapse
|
6
|
Schouten RW, Nadort E, Harmse V, Honig A, van Ballegooijen W, Broekman BFP, Siegert CEH. Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients. J Psychosom Res 2020; 133:109995. [PMID: 32272296 DOI: 10.1016/j.jpsychores.2020.109995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes. METHODS This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding. RESULTS In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45-2.06) p = .007 and Hazard Ratio 1.65 (1.15-2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life. CONCLUSION This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.
Collapse
Affiliation(s)
| | - Els Nadort
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Victor Harmse
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical Psychology, Amsterdam UMC, VUmc, Amsterdam, the Netherlands; Department of Specialized Mental Health Care, GGZ Ingeest, Amsterdam, the Netherlands
| | - Birit F P Broekman
- Department of Psychiatry, OLVG hospital, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, the Netherlands
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Cimen SG, Oğuz E, Gundogmus AG, Cimen S, Sandikci F, Ayli MD. Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial. World J Transplant 2020; 10:79-89. [PMID: 32405474 PMCID: PMC7205904 DOI: 10.5500/wjt.v10.i4.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both end-stage renal disease and being wait-listed for a kidney transplant are anxiety-causing situations. Wait-listed patients usually require arteriovenous fistula surgery for dialysis access. This procedure is performed under local anesthesia. We investigated the effects of music on the anxiety, perceived pain and satisfaction levels of patients who underwent fistula surgery.
AIM To investigate the effect of music therapy on anxiety levels and perceived pain of patients undergoing fistula surgery.
METHODS Patients who were on a waiting list for kidney transplants and scheduled for fistula surgery were randomized to control and music groups. The music group patients listened to music throughout the fistula surgery. The State-Trait Anxiety Inventory was performed to assess anxiety, additionally visual analog scale was used to evaluate perceived pain, willingness to repeat the procedure and patient satisfaction. Demographic features, comorbidities, surgical history, basic surgical data (location of fistula creation, duration of surgery, incision length) and intra-operative hemodynamic parameters were recorded by an investigator blinded to the study group. An additional trait anxiety assessment was performed following the surgery.
RESULTS There was a total of 55 patients included in the study. However, 14 patients did not fulfill the criteria due to requirement of sedation during surgery or uncompleted questionnaires. The remaining 41 patients were included in the analysis. There were 26 males and 15 females. The control and music groups consisted of 20 and 21 patients, respectively. With regard to basic surgical and demographic data, there was no difference between the groups. Overall patient satisfaction was significantly higher and intra-operative heart rate and blood pressure were significantly lower in the music group (P < 0.05). Postoperative state anxiety levels were significantly lower in the music group.
CONCLUSION Music therapy can be a complimentary treatment for patients undergoing fistula surgery. It can reduce anxiety and perceived pain, improve intraoperative hemodynamic parameters and enhance treatment satisfaction, thus may contribute to better compliance of the patients.
Collapse
Affiliation(s)
- Sanem Guler Cimen
- Department of General Surgery, Diskapi Research and Training Hospital, Health Sciences University, Ankara 06110, Turkey
| | - Ebru Oğuz
- Division of Nephrology, Department of Internal Medicine, Diskapi Research and Training Hospital, Health Sciences University, Ankara 06110, Turkey
| | - Ayse Gokcen Gundogmus
- Department of Psychiatry, Diskapi Research and Traning Hospital, Health Sciences University, Ankara 06110, Turkey
| | - Sertac Cimen
- Department of Urology, Diskapi Research and Traning Hospital, Health Sciences University, Ankara 06110, Turkey
| | - Fatih Sandikci
- Department of Urology, Diskapi Research and Traning Hospital, Health Sciences University, Ankara 06110, Turkey
| | - Mehmet Deniz Ayli
- Division of Nephrology, Department of Internal Medicine, Diskapi Research and Training Hospital, Health Sciences University, Ankara 06110, Turkey
| |
Collapse
|
8
|
Awan AA, Zhao B, Anumudu SJ, Winkelmayer WC, Ho V, Erickson KF. Pre-ESKD Nephrology Care and Employment at the Start of Dialysis. Kidney Int Rep 2020; 5:821-830. [PMID: 32518864 PMCID: PMC7270719 DOI: 10.1016/j.ekir.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/12/2020] [Accepted: 03/02/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction Employment is associated with an improved sense of well-being and quality of life in patients with kidney disease. Earlier nephrology referral and longer duration of pre-end-stage kidney disease (ESKD) nephrology care are associated with improved health outcomes in patients with advanced kidney disease who initiate dialysis. It is unknown if pre-ESKD nephrology care helps patients stay employed leading up to dialysis initiation. Methods We used the US ESKD registry to identify adults aged 18-54 years who initiated dialysis between 2007 and 2014. Analyses were restricted to patients who reported being employed 6 months prior to ESKD. We used multivariable regression models with estimated average marginal effects to examine the independent association between ≥6 months of pre-ESKD nephrology care and employment at dialysis initiation. To reduce bias, we conducted an instrumental variable (IV) analysis based on geographic variation in pre-ESKD care. Results Of 75,700 patients included in study cohort, 49% reported receiving pre-ESKD nephrology care for ≥6 months, and 62% were employed at dialysis initiation. Although geographic variation in pre-ESKD nephrology care was strongly associated with the likelihood that working-aged patients in our analytic cohort received pre-ESKD care, the receipt of pre-ESKD nephrology care was not significantly associated with employment at dialysis initiation; estimated probability: 5%; 95% confidence interval (CI) -6% to 14%. Conclusions Pre-ESKD nephrology care 6 months prior to initiation of dialysis is not associated with the likelihood of remaining employed at the initiation of dialysis. Although nephrology care has potential to help patients remain employed, this benefit is not manifested in current practice.
Collapse
Affiliation(s)
- Ahmed A. Awan
- Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
- Correspondence: Ahmed A. Awan, Baylor College of Medicine, 7200 Cambridge Street, Suite 8B, MS: BCM902, Houston, Texas 77030, USA.
| | - Bo Zhao
- Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Samaya J. Anumudu
- Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Wolfgang C. Winkelmayer
- Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Vivian Ho
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston Texas, USA
- Baker Institute for Public Policy, Rice University, Houston, Texas, USA
| | - Kevin F. Erickson
- Selzman Institute for Kidney Health and Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston Texas, USA
- Baker Institute for Public Policy, Rice University, Houston, Texas, USA
| |
Collapse
|
9
|
Işık Ulusoy S, Kal Ö. Relationship Among Coping Strategies, Quality of Life, and Anxiety and Depressive Disorders in Hemodialysis Patients. Ther Apher Dial 2019; 24:189-196. [DOI: 10.1111/1744-9987.12914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Selen Işık Ulusoy
- Başkent University School of MedicinePsychiatry Department Konya Turkey
| | - Öznur Kal
- Başkent University School of MedicineNephrology Department Konya Turkey
| |
Collapse
|
10
|
Schouten RW, Haverkamp GL, Loosman WL, Chandie Shaw PK, van Ittersum FJ, Smets YFC, Vleming LJ, Dekker FW, Honig A, Siegert CEH. Anxiety Symptoms, Mortality, and Hospitalization in Patients Receiving Maintenance Dialysis: A Cohort Study. Am J Kidney Dis 2019; 74:158-166. [PMID: 31027882 DOI: 10.1053/j.ajkd.2019.02.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/09/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. EXPOSURES Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. OUTCOMES All-cause mortality, 1-year hospitalization rate, and hospital length of stay. ANALYTICAL APPROACH Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. RESULTS 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. LIMITATIONS Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. CONCLUSIONS Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.
Collapse
Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands.
| | - Gertrud L Haverkamp
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | | | - Yves F C Smets
- Department of Nephrology, OLVG, Amsterdam, the Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | |
Collapse
|
11
|
Affective and cognitive rather than somatic symptoms of depression predict 3-year mortality in patients on chronic hemodialysis. Sci Rep 2018; 8:5868. [PMID: 29651018 PMCID: PMC5897563 DOI: 10.1038/s41598-018-24267-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/27/2018] [Indexed: 12/16/2022] Open
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.
Collapse
|
12
|
Thomas Z, Novak M, Platas SGT, Gautier M, Holgin AP, Fox R, Segal M, Looper KJ, Lipman M, Selchen S, Mucsi I, Herrmann N, Rej S. Brief Mindfulness Meditation for Depression and Anxiety Symptoms in Patients Undergoing Hemodialysis: A Pilot Feasibility Study. Clin J Am Soc Nephrol 2017; 12:2008-2015. [PMID: 29025788 PMCID: PMC5718270 DOI: 10.2215/cjn.03900417] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Up to 50% of patients undergoing hemodialysis suffer from symptoms of depression and/or anxiety. Access to traditional pharmacotherapies and psychotherapies for depression or anxiety in this patient population has been inadequate. The objective of this study was to investigate the feasibility and effectiveness of brief mindfulness meditation intervention for patients on hemodialysis with depression and anxiety symptoms. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study was a randomized, controlled, assessor-blinded trial conducted in an urban hemodialysis unit. Forty-one patients were randomly assigned to intervention (n=21) and treatment-as-usual (n=20) groups. The intervention group received an 8-week individual chairside meditation intervention lasting 10-15 minutes, three times a week during hemodialysis. Feasibility outcomes were primarily assessed: enrollment rates, intervention completion rates, and intervention tolerability. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). RESULTS Of those deemed eligible for the study, 67% enrolled (41 of 61). Of the participants randomized to the intervention group, 71% completed the study, with meditation being well tolerated (median rating of 8 of 10 in a Likert scale; interquartile range=10-5 of 10). Barriers to intervention delivery included frequent hemodialysis shift changes, interruptions by staff or alarms, space constraints, fluctuating participant medical status, and participant fatigue. Meditation was associated with subjective benefits but no statistically significant effect on depression scores (change in PHQ-9, -3.0±3.9 in the intervention group versus -2.0±4.7 in controls; P=0.45) or anxiety scores (change in GAD-7, -0.9±4.6 versus -0.8±4.8; P=0.91). CONCLUSIONS On the basis of the results of this study, mindfulness meditation appears to be feasible and well tolerated in patients on hemodialysis with anxiety and depression symptoms. The study did not reveal significant effects of the interventions on depression and anxiety scores. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_10_12_CJASNPodcast_17_12_.mp3.
Collapse
Affiliation(s)
- Zoë Thomas
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, and Department of Psychiatry
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Susanna Gabriela Torres Platas
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Maryse Gautier
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
| | - Angela Potes Holgin
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Rebecca Fox
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marilyn Segal
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Karl J. Looper
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark Lipman
- Department of Nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Steven Selchen
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and
| | - Istvan Mucsi
- Multiorgan Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; and
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and
| | - Soham Rej
- McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group and
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and
| |
Collapse
|
13
|
Ogunnubi OP, Olagunju AT, Aina OF, Okubadejo NU. Medication Adherence Among Nigerians with Schizophrenia: Correlation Between Clinico-Demographic Factors and Quality of Life. Ment Illn 2017; 9:6889. [PMID: 28479972 PMCID: PMC5379219 DOI: 10.4081/mi.2017.6889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/23/2022] Open
Abstract
Medication adherence contributes significantly to symptom remission, recovery and wellbeing in mental illnesses. We evaluated how medication adherence correlates with clinico-demographic factors and quality of life (QoL) in a sample of Nigerians with schizophrenia. This descriptive cross-sectional study involved 160 randomly selected participants with confirmed diagnosis of schizophrenia based on MINI International Neuropsychiatric Interview. Data on socio-demographic and clinical characteristics of participants were collected with a questionnaire. Medication adherence was assessed with Morisky Medication Adherence Questionnaire, and participants completed the World Health Organization Quality of Life Scale-BREF. The mean age of participants was 38.54 (±11.30) years, and all the participants were on antipsychotics, but only 45% were adherent to their medication. Out of all the participants, 45 (28.2%) considered their overall QoL to be good, 97 (60.6%) considered theirs to be fair, while 18 (11.2%) reported poor QoL. Medication non-adherence correlated negatively with good QoL across multiple dimensions including overall QoL (r=-0.175), health satisfaction (r=-0.161), physical (r=-0.186) and psychological domain (r=-0.175). Again, participant's age (r=-0.190) and age of onset of illness (r=-0.172) correlated negatively with medication non-adherence, and a trend towards relapse delay with medication adherence was also observed (r=-0.155). The effect size of these correlations were however small. Our findings suggest a link between medication adherence and QoL in schizophrenia, such that strategy that addresses medication non-adherence and its determinants may have potential benefits on wellbeing. Further hypotheses-driven studies are desirable.
Collapse
Affiliation(s)
- Oluseun P Ogunnubi
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria
| | - Andrew T Olagunju
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria.,Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
| | - Olatunji F Aina
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria.,Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Nigeria.,Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Nigeria
| |
Collapse
|
14
|
Taylor JB, Stern TA. Meeting Its Mission: Does Psychosomatics Align With the Mission of Its Parent Organization, the Academy of Psychosomatic Medicine? PSYCHOSOMATICS 2017; 58:375-385. [PMID: 28449827 DOI: 10.1016/j.psym.2017.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vision and mission statements of the Academy of Psychosomatic Medicine (APM) indicate that the APM should promote excellence in clinical care for patients with comorbid psychiatric and general medical conditions by seeking to influence research, public policy, and interdisciplinary education. OBJECTIVE As the APM owns the journal, Psychosomatics, we sought to assess whether the APM's journal was fulfilling the vision and mission of its parent organization by reviewing the content of articles published in the journal to determine whether it sufficiently addresses the various clinical care knowledge areas it seeks to influence. METHODS We categorized content in all review articles, case reports, and original research articles published in Psychosomatics in 2015 and 2016. Each article was assigned to as many categories that it covered. RESULTS In the 163 articles reviewed, the most frequently covered fund of knowledge area was psychiatric morbidity in medical populations (44.2%); among psychiatric disorders, mood disorders (22.1%), psychiatric disorders due to a general medical condition or toxic substance (21.5%), anxiety disorders (14.7%), and delirium (13.5) were the most frequently covered. Of the medical and surgical topics, neurology (19.6%), coping with chronic illness/psychological response to illness (17.8%), toxicology (11.7%), outpatient medicine (10.4%), and cardiology (9.8%) appeared most often. CONCLUSIONS Psychosomatics appears to be successfully providing content relevant to the APM's vision and mission statements and to practitioners of psychosomatic medicine.
Collapse
Affiliation(s)
- John B Taylor
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Theodore A Stern
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
15
|
Lerma A, Perez-Grovas H, Bermudez L, Peralta-Pedrero ML, Robles-García R, Lerma C. Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients. Psychol Psychother 2017; 90:105-123. [PMID: 27435635 DOI: 10.1111/papt.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. DESIGN For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. METHODS Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). RESULTS At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. CONCLUSIONS A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. PRACTITIONER POINTS A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
Collapse
Affiliation(s)
- Abel Lerma
- University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico.,Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico
| | - Héctor Perez-Grovas
- Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico
| | - Luis Bermudez
- London Medical, Medical and Equipment Services, Distrito Federal, Mexico
| | - María L Peralta-Pedrero
- Coordination of High Specialty Medical Units, Mexican Institute of Social Security, Distrito Federal, Mexico
| | - Rebeca Robles-García
- Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico
| |
Collapse
|
16
|
Weiss M, Mettang T, Tschulena U, Weisshaar E. Health-related quality of life in haemodialysis patients suffering from chronic itch: results from GEHIS (German Epidemiology Haemodialysis Itch Study). Qual Life Res 2016; 25:3097-3106. [PMID: 27307011 DOI: 10.1007/s11136-016-1340-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic itch (CI) is a common symptom in haemodialysis (HD) patients affecting about every 4th HD patient. Though it is known that health-related quality of life (HRQOL) is impaired in HD patients, data are lacking on how CI influences HRQOL in this group of patients, also regarding sex differences and the role of sleep and pain. METHODS In order to investigate the itch prevalence and to investigate associated factors, GEHIS (German Epidemiology Haemodialysis Itch Study) was established as first cross-sectional study being representative for all dialysis units in Germany by considering their regional distribution and size of the located city according to population. HRQOL of 860 HD patients from a randomly selected cluster sample of 25 dialysis units was investigated using patient-reported outcomes as the Short-Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS) as well as sleep and pain. Additionally, itch-specific QOL was assessed in HD patients affected by CI using the validated ItchyQoL. RESULTS 42.8 % of HD patients were female. The mean age was 67.2 years (SD ± 13.5). Female patients showed significantly worse values in the mental component summary of the SF-12 as well as in the HADS subscale anxiety compared to male patients. Itch-specific HRQOL did not subject to sex. Patients with impairments in quality of sleep showed significantly worse values in both the SF-12 and the HADS subscales, however not in the ItchyQoL. The occurrence of pain was significantly associated with impaired SF-12, HADS and the ItchyQoL. Multivariate linear regression showed the itch-specific HRQOL to be significantly impaired with rising severity of CI. CONCLUSIONS Impairments in HRQOL are a serious problem in HD patients. CI means an additional burden in affected patients, also impairing their HRQOL. GEHIS showed significant sex differences in HRQOL outcomes also in HD patients. CI and pain as well as sleep frequently occur combined and significantly impair HRQOL in HD patients. The care of HD patients should be complemented by psychosocial support and mental health services.
Collapse
Affiliation(s)
- Melanie Weiss
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht-Karls University Heidelberg, Thibautstrasse 3, 69115, Heidelberg, Germany.
| | - Thomas Mettang
- Department of Nephrology, DKD Helios Clinic, Wiesbaden, Germany
| | | | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht-Karls University Heidelberg, Thibautstrasse 3, 69115, Heidelberg, Germany
| |
Collapse
|
17
|
Shakeri H, Arman F, Hossieni M, Omrani HR, Vahdani A, Shakeri J. Depression, Anxiety and Disease-Related Variables and Quality of Life Among Individuals With Systemic Lupus Erythematosus Living in Kermanshah Province, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e31047. [PMID: 26756021 PMCID: PMC4706992 DOI: 10.5812/ircmj.31047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/23/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is affected by numerous variables including depression and anxiety. However, these associations have not yet been described among patients with systemic lupus erythematosus (SLE) and the impact of SLE-related clinical variables remains unknown. OBJECTIVES In this cross-sectional study, the prevalence of depression and anxiety among Iranian patients with SLE living in Kermanshah province, Iran, has been estimated and the determinants of HRQoL in comparison with healthy subjects have been identified. PATIENTS AND METHODS Sampling was performed based on recruitment of subjects according to inclusion and exclusion criteria. Systemic lupus erythematosus-related variables including cutaneous manifestations, pericarditis, arthritis, history of seizure and psychosis were recorded. Blood samples were taken to measure antinuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), Anti-Smith (Anti-SM), anticardiolipin antibody. Matched healthy subjects in demographic characteristics were selected from general population of Kermanshah province, Iran. Depression and anxiety and HRQoL were assessed using the Beck depression inventory-II, Beck anxiety inventory and short-form 36 health survey, respectively. RESULTS A total of 310 individuals (160 patients with SLE and 150 healthy subjects) participated in this study. The prevalence of depression and anxiety was about 20% among people with SLE, which was noticeably high but not significantly different from healthy individuals. More severe depression was associated with lower scores in domains of physical functioning (PF), role limitation due to physical problems (RP) and subsequently physical component summary (PCS) in the SLE group (P < 0.0001 for all). A higher anxiety level was negatively correlated with PF, RP, social functioning (SF), general health (GH) and PCS in the SLE group (P = 0.01, < 0.0001, 0.004, 0.02 and 0.005, respectively). Scores of PF and PCS were significantly lower among patients with SLE compared to the control group (P = 0.001 for both). Malar rash, photosensitivity, discoid rash, pleuritis, pericarditis, history of seizure and positive Anti-SM Ab were associated with poorer SF (P = 0.003, 0.003, 0.018, 0.001, < 0.0001, 0.021 and 0.002, respectively). CONCLUSIONS The results of this study show that patients with SLE have poorer HRQoL in physical components whereas the mental component of QoL is relatively similar to healthy individuals. Depression and anxiety were not related to clinical manifestations of SLE. However, the SF domain of HRQoL was the most susceptible component of QoL, which was affected by SLE clinical variables. The high estimated prevalence of depression and anxiety among patients with SLE requires attention.
Collapse
Affiliation(s)
- Hania Shakeri
- Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Farid Arman
- Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Monir Hossieni
- Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Hamid Reza Omrani
- Nephrology Department, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Ali Vahdani
- Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Jalal Shakeri
- Psychiatry Department, Farabi Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Author: Jalal Shakeri, Psychiatry Department, School of Medicine, Farabi Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-8314274618, Fax: +98-8314276477, E-mail:
| |
Collapse
|
18
|
Vasilopoulou C, Bourtsi E, Giaple S, Koutelekos I, Theofilou P, Polikandrioti M. The Impact of Anxiety and Depression on the Quality of Life of Hemodialysis Patients. Glob J Health Sci 2015; 8:45-55. [PMID: 26234986 PMCID: PMC4803985 DOI: 10.5539/gjhs.v8n1p45] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 01/16/2023] Open
Abstract
Material and Methods: The sample studied consisted of 395 hemodialysis patients. Data was collected by the completion of a specially designed questionnaire for the needs of the present study which apart from socio-demographic and clinical, it also included HADS scale to assess the level of anxiety and depression as well as the scale Missoula-VITAS Quality of Life Index (MVQOLI) to assess patients’ quality of life. Results: The results of this study showed that 47.8% had high anxiety levels and 38.2% had high levels of depression. The average total score of quality of life was found to be 17.14. It was also shown that the total score of quality of life presented statistically significant association with family status (p=0.007), educational level (p<0.001), the number of children (p=0.001), patients’ adherence to doctors’ orders (p=0.003) and proposed diet (p=0.002) and the relations of patients with healthcare professionals and the other patients (p<0.001). The multiple linear regression showed that the overall quality of life score was statistically associated with the levels of depression after adjusted for possible confounders. More specifically, it was found that total score of quality of life was 2.5 and 4.4 points lower for patients with moderate and high levels of depression, respectively, compared to patients with low levels of depression (p<0.001). Conclusions: Evaluation of anxiety and depression in conjunction with quality of life in hemodialysis patients should be an integral part of the therapeutic regimen.
Collapse
|