| Theme |
Maintenance Dialysis Patients -- Their Fluctnating Minds with Special References to “Depression” |
| Title |
International comparison of depression in hemodialysis patients |
| Author |
Ken-ei Sada |
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences |
| Author |
Shunichi Fukuhara |
Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University |
| [ Summary ] |
Health-related QOL was one major outcome variable present in a large scale international outcome study conducted in relation to the Dialysis Outcomes and Practice Patterns Study (DOPPS). One of the authors of this study conducted an analysis of the prevalence of symptoms of depression as measures with CES-D (Center of Epidemiological Studies Depression Screening Index) and in relation to physician-diagnosed depression, treatments for depression, and the association of these techniques with outcomes such as death. In that study, underdiagnosis was much more common and critical in Japan than in any of 11 other DOPPS countries (2 % vs 17 %), even though the prevalence of depressive symptoms, as indicated by high CES-D scores were similar in Japan to those seen elsewhere (40 % vs 44 %). Concerning treatment techniques, antidepressants were much less prescribed in Japan only 1 % vs 13 % elsewhere. Even patients with physician-diagnosed depression received this medication only 16 % of the time in Japan vs 34 % elsewhere. Instead, benzodiazepine without antidepressants (monotherapy) was commonly used. Proportional relationships (higher CES-D scores are more prevalently used with benzodiazepines monotherapy) are observed in Japan only. In Japan, the prescription of benzodiazepine monotherapy alone was associated with higher mortality rates in hemodialysis patients. Appropriate diagnosis and treatment for patients with depressive symptoms may further reduce mortality in Japan. |