Depression, Anxiety Disorders, Quality of Life and Stress Coping Strategies in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients

摘要

Objective: In this study, we aimed to assess patients with chronic kidney disease on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) and to compare them with matched controls for depression, anxiety disorders, quality of life, and stress coping strategies and to estimate the comorbidity of psychiatric disorders and related risk factors.Patients and Methods: Patients with chronic kidney disease treated with hemodialysis (42 patients) and those with CAPD (41 patients) were included in this study. A healthy control group (41 volunteers) with matched baseline sociodemographic characteristics was also included. Patients between the ages of 18–65 with a history of ≥1 year of dialysis therapy, who were literate and signed an informed consent were allowed to participate; patients with a history of known dementia, delirium, organic brain syndrome (OBS), mental retardation, psychosis, bipolar disorder, or those who were under the influence of a substance or alcohol that disrupted cooperation, sense of reality and cognitive functions and thereby interfered with the evaluation were excluded from the study. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to assess current psychiatric disorders. Additional data were also collected from the Hospital Anxiety and Depression Scale (HADS), Health Related Quality of Life Short Form-36 (SF-36), COPE (Coping strategies with stress) Inventory, and sociodemographic data forms.Results: According to the SCID-I assessment, 59.5% of the patients in the hemodialysis group, 53.7% in the CAPD group, and 26.8% among controls were diagnosed with a psychiatric disorder. In all three groups, the most common psychiatric disorder was depressive disorder. The use of non-functional coping strategies was higher among the patients who were treated with hemodialysis, compared to the CAPD patients. The physical and mental scores of the SF-36 were higher among the patients who were treated with CAPD, compared to those in the hemodialysis group.Conclusion: As both chronic kidney disease and its treatment are very troublesome, it differs from other chronic diseases, leading to a high incidence of psychiatric disorders. Thus, regular psychiatric assessment of these patients is necessary to effectively diagnose and treat psychiatric disorders and improve quality of life.?ZETAma?: Bu ?al??mada hemodiyaliz ve sürekli ayaktan periton diyalizi (SAPD) tedavisi uygulanan kronik b?brek hastalar? ve kontrol grubu kat?l?mc?lar?n? depresyon, anksiyete bozukluklar?, ya?am kaliteleri ve stresle ba?a ??kma tutumlar? a??s?ndan kar??la?t?rmak, psikiyatrik hastal?klarla kar??la?ma s?kl???n? ve bununla ili?kili fakt?rleri belirlemek ama?lanm??t?r.Y?ntem: ?al??mam?za 42 hemodiyaliz ve 41 SAPD tedavisi alan kronik b?brek yetmezli?i hastas? ile hasta gruplar?yla benzer sosyodemografik ?zellikler g?steren 41 sa?l?kl? ki?i al?nd?. ?al??maya dahil edilme kriterleri; hastalar?n en az 1 y?ld?r diyaliz tedavisi alt?nda olmalar?, okuryazar olmalar?, ara?t?rmaya kat?lmay? kabul ederek bilgilendirilmi? onam formunu imzalam?? olmalar?, 18–65 ya? aras?nda olmalar?, ?nceden bilinen demans, deliryum, organik beyin sendromu, mental retardasyon, psikoz veya bipolar bozukluk tan?s? almam?? olmalar? ve g?rü?me s?ras?nda alkol ya da k?tüye kullan?labilen bir maddenin etkisi alt?nda olmak gibi hastan?n kooperasyonunu, ger?e?i de?erlendirme yetisini ve bili?sel fonksiyonlar?n? bozarak, g?rü?me yapmay? ya da ?l?ekleri doldurmay? engelleyen durumlar?n bulunmamas? olarak al?nm??t?r. Hastalarda psikiyatrik bozukluk varl???n? belirlemek amac?yla ilk g?rü?mede DSM-IV Eksen-I Bozukluklar? i?in Yap?land?r?lm?? Klinik G?rü?me (SCID-I) uyguland?. Ayr?ca Hastane Anksiyete ve Depresyon ?l?e?i (HADS), K?sa Form-36 (SF-36) Ya?am Kalitesi ?l?e?i, Stresle Ba?a ??kma Tutumlar? ?l?e?i (COPE) ve sosyodemografik veri formlar? kullan?larak veriler topland?.Bulgular: SCID-I'e g?re hemodiyaliz hastalar?n?n %59,5′ine, SAPD hastalar?n?n %53,7′sine ve kontrol grubunun %26,8′ine psikiyatrik bozukluk tan?s? konuldu. Her ü? grupta da en s?k depresif bozukluklar g?rüldü. Stresle ba?a ??kmada, hemodiyaliz hastalar?n?n SAPD hastalar?na g?re i?levsel olmayan ba?a ??kma tutumlar?n? istatistiksel a??dan anlaml? olarak daha fazla kulland?klar? g?rüldü. SAPD hastalar?n?n K?sa Form-36 fiziksel ve ruhsal bile?en skorlar?n?n ise hemodiyaliz hastalar?na g?re daha yüksek oldu?u g?zlendi.Sonu?: Kronik b?brek yetmezli?inin kendisi kadar tedavi y?nteminin de olduk?a zorlay?c? olmas? di?er kronik hastal?klardan ayr?lmas?na ve psikiyatrik bozukluklar?n olduk?a yayg?n g?rülmesine neden olmaktad?r. Sonu? olarak hastalar?n psikiyatrik a??dan de?erlendirilmesi psikiyatrik hastal?klar?n tan? konup tedavi edilmesi ve ya?am kalitelerinin artt?r?lmas? i?in olduk?a ?nemlidir.