Journal
PSYCHOSOMATIC MEDICINE
Volume 81, Issue 7, Pages 649-658Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PSY.0000000000000723
Keywords
depression; dimensions; CKD; dialysis; mortality; hospitalization; BDI = Beck Depression Inventory-II; CFA = Confirmatory Factor Analysis; CFI = comparative fit index; CKD = chronic kidney disease; DSM = Diagnostic and Statistical Manual of Mental Disorders; G-S-C model = general-somatic-cognitive dimensions of the BDI; HR = hazard ratio; QoL = quality of life; RMSEA = root mean square error of approximation; SF-12=12-item Short Form Health Survey; 95% CI=95% confidence interval of the corresponding effect measure estimate
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Funding
- Dutch Kidney Association [SB 174]
- OLVG Hospital in Amsterdam
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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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