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Anxiety disorders in adults treated by hemodialysis: a single-center study.
Am J Kidney Dis. 2008 Jul; 52(1):128-36.AJ

Abstract

BACKGROUND

Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population.

STUDY DESIGN

To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status.

SETTING & PARTICIPANTS

A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center.

PREDICTOR

Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I).

OUTCOMES

HADS and Kidney Disease Quality of Life Short Form.

RESULTS

Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05).

LIMITATIONS

Single-center study and a population not representative of US demographics.

CONCLUSIONS

A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD.

Authors+Show Affiliations

Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA. daniel.cukor@downstate.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18440682

Citation

Cukor, Daniel, et al. "Anxiety Disorders in Adults Treated By Hemodialysis: a Single-center Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 52, no. 1, 2008, pp. 128-36.
Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis. 2008;52(1):128-36.
Cukor, D., Coplan, J., Brown, C., Friedman, S., Newville, H., Safier, M., Spielman, L. A., Peterson, R. A., & Kimmel, P. L. (2008). Anxiety disorders in adults treated by hemodialysis: a single-center study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 52(1), 128-36. https://doi.org/10.1053/j.ajkd.2008.02.300
Cukor D, et al. Anxiety Disorders in Adults Treated By Hemodialysis: a Single-center Study. Am J Kidney Dis. 2008;52(1):128-36. PubMed PMID: 18440682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anxiety disorders in adults treated by hemodialysis: a single-center study. AU - Cukor,Daniel, AU - Coplan,Jeremy, AU - Brown,Clinton, AU - Friedman,Steven, AU - Newville,Howard, AU - Safier,Michal, AU - Spielman,Lisa A, AU - Peterson,Rolf A, AU - Kimmel,Paul L, Y1 - 2008/04/28/ PY - 2007/08/10/received PY - 2008/02/26/accepted PY - 2008/4/29/pubmed PY - 2008/8/1/medline PY - 2008/4/29/entrez SP - 128 EP - 36 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 52 IS - 1 N2 - BACKGROUND: Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population. STUDY DESIGN: To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status. SETTING & PARTICIPANTS: A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center. PREDICTOR: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I). OUTCOMES: HADS and Kidney Disease Quality of Life Short Form. RESULTS: Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05). LIMITATIONS: Single-center study and a population not representative of US demographics. CONCLUSIONS: A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18440682/Anxiety_disorders_in_adults_treated_by_hemodialysis:_a_single_center_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)00530-1 DB - PRIME DP - Unbound Medicine ER -