| Background and SignificanceChronic renal failure is one of the major diseases which is threaten human health gravely.Furthermore because of a variety of reasons renal parenchyma is progressively damaged by chronic renal failure,which lead the kidney to be unable to maintain its basic function,thus the azotemia and metabolic disorders appeare,and each organ of the whole body would be affected.Patients with chronic renal failure suffer from many factors such as the long treatment cycle,high recurrence rate and heavy economic burden.These factors can easily lead patients to depression or other emotional disturbance and affect the quality of life of patients.At present,there are many domestic researches on the psychological status and quality of life of the patients who have been on renal dialysis.However fewer researches on depression status and quality of life of patients without renal dialysis.The ultimate targets of comprehensive and effective evaluation on the health status and intervention measures is to improve the quality of life of non-dialysis chronic renal failure patients.Therefore,this research evaluates the quality of life and depression of non-dialysis chronic renal failure patients by questionnaire survey and investigate these factors which could influence the quality of life and depression of non-dialysis chronic renal failure patients.It would have a positive effect on improvement quality of life of the patients and paying more attention to the mental health of patients during diagnosis and treatment.ObjectivesTo analyze the quality of life of non-dialysis chronic renal failure patients and how these factors could influence the patients.To identify the principal influence factors for depression in non-dialysis chronic renal failure patients.To establish a depression risk assessment model of non-dialysis chronic renal failure patients based on local population and their characteristics.It provided reference for the early screening of depression patients and the definition of high-risk groups.Contents and MethodsThe principle of convenience sampling was used and the range of non-dialysis chronic renal failure patients was collected in four hospitals of Chongqing with QLICD-CRF2.0 quality of life scale to investigate the quality of life of the patients and BDI-II depression scale to investigate the depression of patients.In addition,the general data of patients were collected to analyze quality of life of the patients and factors that could influence the situation of depression of patients without dialysis.Besides,a preliminary depression risk assessment model would be established.Moreover,there were many analyses for establishing depression risk assessment model such as single factor analysis,Spearman correlation analysis,multiple stepwise linear regression analysis,Chi-square analysis,two independent samples t-test and binary logistic regression analysis.These data would be used in analyzing the factors could influence the quality of life and the status of depression of patients.Then the depression risk assessment model was built with Fisher discriminant function.Results520 questionnaires were issued in this survey and 492 questionnaires were valid.The effective response rate occupied at 95.91% including 284 males and 208 females with an average age around 61.33±14.96.The quality of life divided into four dimensions,and 58.43±17.03 points for physiological function,59.44±19.32 points for psychological function,67.42±16.11 points for social function and 28.71±15.96 points for specific module.The total score of quality of life scale was 50.82±11.86.It indicated the whole quality of life of non-dialysis chronic renal failure patients remained a poor situation in Chongqing.The incidence rate of depression in 492 patients occupied 49.19% and the whole quality of life of the depressed patients was under that of non-depressed patients.The score of patients' BDI depression scale was an important factor affecting the quality of life of patients.Physiological function,psychological function,social function and total score of the scale were negatively correlated with the score of the BDI depression scale.While the specific module is positively correlated with the score of the BDI depression scale.The quality of life of non-dialysis chronic renal failure patients would be influenced by these factors including total score of BDI depression scale,clinical stages,place of residence,age,frequency of hospitalization,type of treatment,time of renal function reexamination,per capita annual income of households,monthly treatment cost,marital status,period of illness and main original diseases.In these factors,physiological function was negatively correlated with the total score of BDI scale,age,hospitalization frequency and clinical stage(P<0.05).Meanwhile,psychological function was negatively correlated with the total score of BDI scale,annual income per capita of family,residence,monthly treatment cost and marital status(P<0.05).Social function was negatively correlated with the total score of BDI scale,clinical stage and residence,and positively correlated with the type of medical treatment and the time of renal function reexamination(P<0.05).The specificity module was positively correlated with the total score of BDI scale,age,clinical stage,duration of illness,and negatively correlated with the number of hospitalizations and major primary diseases(P<0.05).The total score of the scale was negatively correlated with the total score of the BDI scale,the place of residence and the per capita annual income of the family,and positively correlated with the type of medical treatment and the time of renal function reexamination(P<0.05).Multivariate logistic stepwise regression analysis showed that the influencing factors of depression in non-dialysis chronic renal failure patients were hospitalization frequency,per capita annual income,monthly treatment costs,the scores of psychological function,and the scores of specific module respectively.Additionally patients with per capita family income < 10,000 yuan were 7.758 times more likely to have depression than those with per capita family income >50,000yuan(OR=7.758,95%CI: 2.702 ~ 22.269,P<0.001).The risk of depression in patients with per capita family income about 10,000 to 30,000 yuan was 2.404 times that of patients with per capita family income of >50,000yuan(OR=2.404,95%CI: 1.041 ~ 5.553,P=0.04<0.05).The discriminant function of the depression risk assessment model was Z=1.067* type of treatment-0.201* times of hospitalization-0.39* residence-0.201* occupation +0.33* per capita annual income of family +0.042* mental function-0.026 * specific module-3.149.In order to further enhance the predictive efficiency of the model,the evaluation and screening of depression risk in non-dialysis chronic renal failure patients in this region could be considered.However,it is still necessary to launch larger sample prospective cohort studies and follow-up in the future research.While the model should be verified and revised in time.ConclusionIn this research,the whole quality of life of non-dialysis chronic renal failure patients was at a lower level,a high incidence of depression.The quality of life of CRF depressed patients was lower that of non-depressed patients.What is more,we need to focus on the depression of patients with non-dialysis chronic renal failure who live in rural areas and have an annual household income of less than 10,000 yuan.The established depression risk assessment model can help medical personnel to identify and screen high-risk groups in early diagnosis and treatment in the future time.Thus doctors and nurses can carry out targeted diagnosis and treatment.The risk assessment model which is of great significance to improve the overall quality of life of patients of depression provides a reference for the early prevention and treatment of depression in non-dialysis chronic renal failure patients. |
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