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Biopsychosocial aspects of long-term survival on end-stage renal failure therapy

Published online by Cambridge University Press:  09 July 2009

Ralph Shulman ,
John D. E. Price  and
John Spinelli
Ralph Shulman*
Affiliation:
Departments of Psychiatry and Medicine and the Centre for Epidemiological Studies, Cancer Control Agency, University of British Columbia, Vancouver, Canada
John D. E. Price
Affiliation:
Departments of Psychiatry and Medicine and the Centre for Epidemiological Studies, Cancer Control Agency, University of British Columbia, Vancouver, Canada
John Spinelli
Affiliation:
Departments of Psychiatry and Medicine and the Centre for Epidemiological Studies, Cancer Control Agency, University of British Columbia, Vancouver, Canada
*
1Address for correspondence: Dr Ralph Shulman, University Hospital UBC Site, Department of Psychiatry, 2211 Westbrook Mall, Vancouver, B.C. Canada V6T 2B5.
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Synopsis

At ten-years follow-up of 64 haemodialysis patients, 43 had died and 21 were alive, twelve with cadaver renal transplants and nine on haemodialysis. Examination of the influence of psychological, demographic, physical and biochemical factors revealed the Beck Depression Inventory and age as the two most important predictors of survival. The behaviour of the patient was directly responsible for five (11·6%) of the deaths, by suicide in three cases and dietary noncompliance in two cases. Hypothetical mechanisms linking depression with reduced survival have been reviewed. As the impact of depression on survival was maximal in the first few years of dialysis, monitoring for depression should be incorporated into routine care from the start of dialysis together with evaluative interventions that might enhance survival.

Type
Original Articles
Information
Psychological Medicine , Volume 19 , Issue 4 , November 1989 , pp. 945 - 954
Copyright
Copyright © Cambridge University Press 1989

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