Underrecognition of Depression in Mexican Americans with ESKD on Hemodialysis

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Background: Depression is prevalent among ESKD patients on maintenance hemodialysis (HD) and associated with adverse outcomes, including hospitalization, dialysis withdrawal, and mortality. Clinicians often underrecognize and undertreat depression in HD patients. According to the recent United States Renal Data System Annual Data Report, the adjusted incidence of ESKD in Hispanics is more than twice that of Whites. However, data on the prevalence, diagnosis, and treatment of depression among Mexican Americans with ESKD receiving HD are limited. Methods: We enrolled Mexican American HD patients (n = 112) who had been on maintenance dialysis for ≥6 months from hemodialysis centers at a Hispanic serving teaching hospital. Symptoms and severity of depression was assessed using the validated Beck Depression Inventory-II (BDI-II), where higher scores indicating more severe depression. Clinical data on documented depression and antidepressant prescriptions were obtained via chart review in Epic. Results: The mean age of study participants was 54.8 ± 12.8 years and 47.8% were female. The mean BDI-II score was 15.01 ± 1.02. Based on the BDI-II cutoff score of ≥16 to identify major depressive disorder, the prevalence of depression was 45.5%. Depressed patients had significantly higher BDI-II scores compared to non-depressed patients (24.76 ± 1.11 vs. 6.85 ± 0.49; P <0.0001). Depression severity categorized using the validated cutoff scores found: no depression (BDI-II <10) in 38.4%, mild (10–15) in 18.8%, moderate (16–23) in 21.4%, and severe (≥24) in 21.4% of study participants. Prevalence of clinically documented depression was 20.5%, and among those with clinically documented depression 83.9% received antidepressant prescriptions. Conclusion: Questionnaire-based depression prevalence among Mexican American HD patients is markedly higher (45.5%) than previously reported rates in African Americans (30.6%) and Whites (25.8%) using comparable BDI-II cut off score. However, depression may be clinically underrecognized. These findings also highlight the need for further research to understand the causes of high prevalence of depression in this high-risk minority population with an increased rate of ESKD. Interview-based depression diagnosis may help establish the true prevalence.

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