Renal-Electrolyte Division, Department of Medicine and.
Center for Health Equity Research and Promotion and.
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):298-303. doi: 10.2215/CJN.07720716. Epub 2017 Jan 26.
Depression is common in patients receiving chronic hemodialysis but seems to be ineffectively treated. We investigated the acceptance of antidepressant treatment by patients on chronic hemodialysis and their renal providers.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: As part of a clinical trial of symptom management in patients on chronic hemodialysis conducted from 2009 to 2011, we assessed depression monthly using the Patient Health Questionnaire 9. For depressed patients (Patient Health Questionnaire 9 score ≥10), trained nurses generated treatment recommendations and helped implement therapy if patients and providers accepted the recommendations. We assessed patients' acceptance of recommendations, reasons for refusal, and provider willingness to implement antidepressant therapy. We analyzed data at the level of the monthly assessment.
Of 101 patients followed for ≤12 months, 39 met criteria for depression (Patient Health Questionnaire 9 score ≥10 on one or more assessments). These 39 patients had depression on 147 of 373 (39%) monthly assessments. At 103 of these 147 (70%) assessments, patients were receiving antidepressant therapy, and at 51 of 70 (70%) assessments, patients did not accept nurses' recommendations to intensify treatment. At 44 assessments, patients with depression were not receiving antidepressant therapy, and in 40 (91%) instances, they did not accept recommendations to start treatment. The primary reason that patients refused the recommendations was attribution of their depression to an acute event, chronic illness, or dialysis (57%). In 11 of 18 (61%) instances in which patients accepted the recommendation, renal providers were unwilling to provide treatment.
Patients on chronic hemodialysis with depression are frequently not interested in modifying or initiating antidepressant treatment, commonly attributing their depression to a recent acute event, chronic illness, or dialysis. Renal providers are often unwilling to modify or initiate antidepressant therapy. Future efforts to improve depression management will need to address these patient- and provider-level obstacles to providing such care.
在接受慢性血液透析的患者中，抑郁症较为常见，但似乎治疗效果不佳。我们调查了慢性血液透析患者及其肾脏提供者对接受抗抑郁治疗的态度。
设计、地点、参与者和测量：作为 2009 年至 2011 年期间进行的慢性血液透析患者症状管理临床试验的一部分，我们每月使用患者健康问卷 9 评估抑郁情况。对于患有抑郁症的患者（患者健康问卷 9 评分≥10），经过培训的护士会生成治疗建议，并在患者和提供者接受建议的情况下帮助实施治疗。我们评估了患者对建议的接受程度、拒绝的原因以及提供者实施抗抑郁治疗的意愿。我们在每月评估的层面上分析数据。
在随访时间≤12 个月的 101 名患者中，有 39 名符合抑郁症标准（患者健康问卷 9 评分在一次或多次评估中≥10）。这 39 名患者在 373 次月度评估中有 147 次（39%）患有抑郁症。在这 147 次评估中的 103 次（70%），患者正在接受抗抑郁治疗，而在 70 次评估中的 51 次（70%），患者不接受护士加强治疗的建议。在 44 次评估中，患有抑郁症的患者未接受抗抑郁治疗，而在 40 次评估中（91%），他们不接受开始治疗的建议。患者拒绝建议的主要原因是将他们的抑郁症归因于急性事件、慢性疾病或透析（57%）。在 18 次（61%）患者接受建议的情况下，肾脏提供者不愿意提供治疗。
患有慢性血液透析的抑郁症患者常常对改变或开始抗抑郁治疗不感兴趣，他们通常将抑郁症归因于最近的急性事件、慢性疾病或透析。肾脏提供者通常不愿意改变或开始抗抑郁治疗。未来改善抑郁症管理的努力将需要解决这些患者和提供者层面的障碍，以提供此类护理。
