Background: Depression is common in chronic physical illness, including renal graft recipients. There is evidence that depression is an independent marker of poorer prognosis in dialysis patients. In the UK, screening is advocated by the National Institute for Health and Clinical Excellence guidelines, and validated screening tools exist, such as the Beck Depression Inventory (BDI). Methods: We audited our renal graft recipient outpatient clinic to see if screening was being undertaken by our clinicians, and to confirm the rates of depressive symptoms in our population as reported by the BDI. Results: In a sample of 58 transplant patients, we found that the screening rate for depression was poor, particularly by nephrologists (n = 8, 13.8%). In addition, 13 (22.4%) of our patients had significant depressive symptoms (BDI score ≧16). Following univariate analysis, we found that the most important predictor of current significant depressive symptoms was a past history of depression. Conclusions: Despite the limitations of our small audit, our results confirm that depression is under-screened in renal graft recipients, even in those with a known history of depression. We recommend increased awareness of depression and implementation of regular screening in an outpatient setting; in this regard, the BDI may have utility.

1.
Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ: Prevalence of major depressive episode in CKD. Am J Kidney Dis 2009;54:424–432.
2.
Wulsin LR, Vaillant GE, Wells VE: A systematic review of the mortality of depression. Psychosom Med 1999;61:6–17.
3.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007;370:851–858.
4.
Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A: No health without mental health. Lancet 2007;370:859–877.
5.
Boulware LE, Liu Y, Fink NE, Coresh J, Ford DE, Klag MJ, Powe NR: Temporal relation among depression symptoms, cardiovascular disease events, and mortality in end-stage renal disease: contribution of reverse causality. Clin J Am Soc Nephrol 2006;1:496–504.
6.
Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 2000;57:2093–2098.
7.
Karaminia R, Tavallaii SA, Lorgard-Dezfuli-Nejad M, Moghani LM, Hadavand MH, Einollahi B, Firoozan A: Anxiety and depression: a comparison between renal transplant recipients and hemodialysis patients. Transplant Proc 2007;39:1082–1084.
8.
Szeifert L, Molnar MZ, Ambrus C, Koczy AB, Kovacs AZ, Vamos EP, Keszei A, Mucsi I, Novak M: Symptoms of depression in kidney transplant recipients: a cross-sectional study. Am J Kidney Dis 2010;55:132–140.
9.
Sensky T: Psychiatric morbidity in renal transplantation. Psychother Psychosom 1989;52:41–46.
10.
Akman B, Ozdemir FN, Sezer S, Micozkadioglu H, Haberal M: Depression levels before and after renal transplantation. Transplant Proc 2004;36:111–113.
11.
Petrie K: Psychological well-being and psychiatric disturbance in dialysis and renal transplant patients. Br J Med Psychol 1989;62:91–96.
12.
Sugawara H, Nishimura K, Kobayashi S, Ishida H, Tanabe K, Ishigooka J: Paradoxical depression in renal transplant recipients. Transplant Proc 2008;40:3448–3450.
13.
World Health Organisation: The International Statistical Classification of Diseases and Related Health Problems, 10th revision. Geneva, WHO, 2007.
14.
Virzi A, Signorelli MS, Veroux M, Giammarresi G, Maugeri S, Nicoletti A, Veroux P: Depression and quality of life in living related renal transplantation. Transplant Proc 2007;39:1791–1793.
15.
Muehrer RJ, Becker BN: Life after transplantation: new transitions in quality of life and psychological distress. Semin Dial 2005;18:124–131.
16.
Dobbels F, Skeans MA, Snyder JJ, Tuomari AV, Maclean JR, Kasiske BL: Depressive disorder in renal transplantation: an analysis of Medicare claims. Am J Kidney Dis 2008;51:819–828.
17.
Cukor D, Newville H, Jindal R: Depression and immunosuppressive medication adherence in kidney transplant patients. Gen Hosp Psychiatry 2008;30:386–387.
18.
Watnick S, Kirwin P, Mahnensmith R, Concato J: The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis 2003;41:105–110.
19.
Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, Van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O’Connor CM: Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation 2003;108:939–944.
20.
Hedayati SS, Finkelstein FO: Epidemiology, diagnosis, and management of depression in patients with CKD. Am J Kidney Dis 2009;54:741–752.
21.
National Institute For Health and Clinical Excellence: CG23: Depression. London, National Institute for Health and Clinical Excellence, 2007.
22.
Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–370.
23.
Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282:1737–1744.
24.
Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ: Validation of depression screening scales in patients with CKD. Am J Kidney Dis 2009;54:433–439.
25.
Watnick S, Wang PL, Demadura T, Ganzini L: Validation of 2 depression screening tools in dialysis patients. Am J Kidney Dis 2005;46:919–924.
26.
Chilcot J, Wellsted D, Farrington K: Screening for depression while patients dialyse: an evaluation. Nephrol Dial Transplant 2008;23:2653–2659.
27.
Grant D, Almond MK, Newnham A, Roberts P, Hutchings A: The Beck Depression Inventory requires modification in scoring before use in a haemodialysis population in the UK. Nephron Clin Pract 2008;110:c33–c38.
28.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
29.
Beck AT, Steer RA, Brown GK: Beck Depression Inventory, ed 2. San Antonio, Psychological Corporation, 1996.
30.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
31.
Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 1988;8:77–100.
32.
Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA: The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int 2006;69:1662–1668.
33.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461–470.
34.
Davies SJ, Russell L, Bryan J, Phillips L, Russell GI: Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival. Am J Kidney Dis 1995;26:353–361.
35.
National Institute For Health and Clinical Excellence: CG91: Depression in Adults with a Chronic Physical Health Problem. London, National Institute for Health and Clinical Excellence, 2009.
36.
Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM: Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288:351–357.
37.
Simic OS, Jovanovic D, Dopsaj V, Radovic M, Sumarac Z, Bogavac SN, Stosovic M, Stanojevic M, Nesic V: Could depression be a new branch of MIA syndrome? Clin Nephrol 2009;71:164–172.
38.
Cukor D, Coplan J, Brown C, Peterson RA, Kimmel PL: Course of depression and anxiety diagnosis in patients treated with hemodialysis: a 16-month follow-up. Clin J Am Soc Nephrol 2008;3:1752–1758.
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