Key result
The somatic dimension of depressive symptoms in dialysis patients was significantly associated with all-cause mortality (HR 1.7; 95% CI 1.2-2.5; p<0.007).
Why the study?
Unraveling specific dimensions of depressive symptoms may help improve screening and treatment in dialysis patients.
Are specific dimensions of depressive symptoms associated with mortality, hospitalization, and quality of life in chronic dialysis patients?
Cohort (n=687)
Yes
Are specific dimensions of depressive symptoms associated with mortality, hospitalization, and quality of life in chronic dialysis patients?
Hazard Ratio: 1.7 (95% CI 1.2–2.5)
p-value: p=<0.007
The somatic dimension of depressive symptoms is significantly associated with increased all-cause mortality, higher hospitalization rates, and reduced quality of life in chronic dialysis patients.
Somatic BDI-II symptoms associated with mortality, hospitalization, and lower QoL in dialysis; leaves open screening utility pending prospective validation.
OBJECTIVE: Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment in dialysis patients. We aimed to identify the best-fitting factorial structure for the Beck Depression Inventory-II (BDI) in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality. METHODS: This prospective study included chronic dialysis patients from 10 dialysis centers in five hospitals between 2012 and 2017. Dimensions of depressive symptoms within the BDI were analyzed using confirmatory factor analysis. To investigate the clinical impact of these dimensions, the associations between symptom dimensions and QoL, hospitalization rate, and mortality were investigated using logistic, Poisson, and Cox proportional hazard regression models. Multivariable regression models included demographic, social, and clinical variables. RESULTS: In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best-fitting structure of the BDI-II. Only the somatic dimension scores were associated with all-cause mortality (hazard ratio of 1.7 [1.2-2.5], p < .007) in the multivariable model. All dimensions were associated with increased hospitalization rate and reduced QoL. CONCLUSIONS: The somatic dimension of the BDI-II in dialysis patients was associated with all-cause mortality, increased hospitalization rate, and reduced QoL. Other dimensions were associated with hospitalization rate and decreased QoL. These findings show that symptom dimensions of depression have differential association with adverse clinical outcomes. Future studies should take symptom dimensions into account when investigating depression-related pathways, screening, and treatment effects in dialysis patients.
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Schouten et al. (2019) conducted a cohort in chronic dialysis (n=687). Somatic dimension of depressive symptoms (BDI-II) was evaluated on all-cause mortality (HR 1.7, 95% CI 1.2-2.5, p=<0.007). The somatic dimension of depressive symptoms in dialysis patients was significantly associated with all-cause mortality (HR 1.7; 95% CI 1.2-2.5; p<0.007).
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