Posttraumatic stress disorder in hemodialysis patients

Sefik Tagay, Andreas Kribben, Alexander Hohenstein, Ricarda Mewes, Wolfgang Senf
American Journal of Kidney Diseases 2007, 50 (4): 594-601

BACKGROUND: We aim to assess the prevalence and severity of posttraumatic stress disorder (PTSD) in patients who receive long-term hemodialysis (HD) and investigate its correlation with depression, anxiety, health-related quality of life, and service utilization.

STUDY DESIGN, SETTING & PARTICIPANTS: In a cross-sectional study, we recruited 144 HD patients (age, 63.1 +/- 14.2 years; 50.7% men) from 5 dialysis units.

FACTOR: PTSD, defined in accordance with criteria of the Impact of Event Scale-Revised and Posttraumatic Stress Diagnostic Scale.

OUTCOMES: Physical health, mental health, depression, anxiety, life satisfaction, service utilization.

MEASUREMENTS: Impact of Event Scale-Revised, Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey.

RESULTS: 77.8% of HD patients reported at least 1 traumatic event. The lifetime prevalence for PTSD, independent from trauma type, was 17%. PTSD prevalence only with regard to HD as a potential traumatic event was 10.4%. Women reported more helplessness and more intensive experiences of fear or horror than men with respect to the stressor A criterion. Patients with PTSD showed substantial decreases in mental health in comparison to patients without PTSD (P < 0.01). Additionally, greater depression, anxiety, less life satisfaction, and more service utilization were associated with greater posttraumatic symptoms. There was no correlation of physical health with posttraumatic symptoms. In partial correlation analyses adjusting for depression, associations between posttraumatic symptoms, mental health, and anxiety remained robust.

LIMITATIONS: Generalizability to other settings, absence of control group, study power.

CONCLUSIONS: PTSD is common in HD patients, but little work has been done to explore the variables associated with PTSD. Data suggest that PTSD is underdiagnosed and undertreated in HD patients. Interventions should target these patients with the goal to improve well-being and quality of life.

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