혈액투석 환자에서 보는 우울증의 특징과 이에 영향을 미치는 요인

Abstract

Based on the recent clinical experiences, the pattern of depression in the hemodialysis patients seems to have changed as compared to the past This study is designed to find out the characteristics of depression in the hemodialysis patients nowadays and factors influencing the depression. Fifty End Stage Renal Disease(ESRD) patients receiving hemodialysis were interviewed according to a schedule to collect data. Their depression was assessed with Hamilton’s Depression Scale and Zungs Self Rating Scale. The data were compared with 45 patients who were diagnosed as neurotic depression in psychiatric outpatients clinic. The results are as follows : 1) The depression in hemodialysis patients was not more severe than that of neurotic depression. This suggests that the severity of depression in the hemodialysis patients have decreased apparently as compared to the past. This may be due to general socioeconomic improvement in Korean society, improved financial support by medical insurance system, improvement of therapeutic techniques and environments of hemodialysis rooms and changed view on hemodialysis of the people. Fear of death and fear of life, and fear of dependence to the machines that were used to be attributed to the depression in the past were still influential, but less than the past. 2) Comparing with neurotic patients, the hemodialysis patients presented less of depressive symptoms such as depressed mood, agitation, anxiety(psychological, physical) and somatic symptoms. Thus, the psychological symptoms such as low of interest and suicidal ideation are more valuable to evaluate the depression of the hemodialysis patients than vegetative symptoms. 3) Economic problem appeared to be the most significant cause of depression in the hemodialysis patients. Other causes were family problem and sexual problem. The duration of hemodialysis is longer, the depression is more sever and the severity of depression tended to increase as the patients get old. 4) In the hemodialysis patients, religion and higher education appeared to be related with less severity of depression. Thus, to help the patients, it is recommended the hemodialysis patients to have religious faith and the educational programs