B5(W)
EFFECTIVENESS OF MANAGEMENT OF DEPRESSION IN MAINTENANCE
HAEMODIALYSIS PATIENTS
McCloskey, M, Masengu, A, Mullan, R, Cunningham, R, Harron, C
Renal Unit, Antrim Area Hospital, Antrim, Northern Ireland
PURPOSE/OBJECTIVE: Depression is common in haemodialysis patients, is associated
with adverse clinical outcomes and places an increased burden on health care resources.1 The
purpose of this audit was to determine the prevalence of depression within our haemodialysis
population and to determine how effective we are at detecting and managing those patients
with depressive symptoms.
METHOD: A total of 126 haemodialysis patients were asked to complete a voluntary
depression questionnaire when they attended for their regular haemodialysis. The tool used
was the patient health questionnaire 9 (PHQ-9), which is a depression assessment tool scoring
each of the 9 diagnostic and statistical manual IV (DSM-IV) criteria for depression. The
PHQ-9 assessment tool is used by general practitioners and has been validated for use.2
We identified those patients who were already on antidepressant medication at the time of the
assessment and the dose that had been prescribed, using our computerised database.
RESULTS: 76.2% (96/126) completed the questionnaire, 15.9% (20/126) refused, 0.8%
(1/126) were unable to complete the questionnaire secondary to poor English, and 6.3%
(8/126) were unable to complete the questionnaire secondary to cognitive impairment. 32.5%
(41/126) of those on haemodialysis were already on an antidepressant. 42.7% (41/96) of
those who completed the questionnaire were identified as being depressed. 29.2% (28/96)
were classified as being mildly depressed, 35.7% (10/28) of whom were already on an
antidepressant. 8.3% (8/96) were classified as moderately depressed, 25% (2/8) of whom
were already on an antidepressant. 4.2% (4/96) were classified as moderately severely
depressed, 75% (3/4) of whom were already on an antidepressant, and one patient was
classified as severely depressed and was already on an antidepressant. 39.02% (16/41) of
those who were classified as depressed were already on antidepressant medication.
CONCLUSION: Our results show that as expected, depression is common in the
haemodialysis population; however it also shows that the majority of depressed
patients are not identified and subsequently treated for depression. The majority of
patients who scored as moderately severely or severely depressed had been started on
medication; however the effectiveness of that treatment was not clear. Those patients
who had been identified as depressed had their management of depression reviewed.
IMPLICATIONS: Depression is common in haemodialysis patients and we need to
establish an effective method of identifying and monitoring those patients with
depressive symptoms, as well as an effective and timely management strategy, in an
effort to improve our patients’ quality of life.
References:
1.
Agganis BT et al. Depression and cognitive function in maintenance
haemodialysis patients. Am J Kidney Dis. 2010; 56(4): 704-12.
2.
General Practice Notebook – a UK medical reference. www.gpnotebook.co.uk