| ObjectiveTo investigate the psychological status of maintenance hemodialysis patients in the blood purification centers of Affiliated Hospital of Qingdao University from 2020.09 to2020.10,collect the relevant socio-demographic and clinical characteristics of patients,and analyze the relevant factors of mental disorders of MHD patients,which is helpful for the early judgment of mental disorders of MHD patients.To investigate the current quality of life of MHD patients,evaluate their suicidal tendencies,and explore the correlation between psychological disorders and quality of life and suicidal tendencies,so as to provide a basis for improving the attention of MHD patients and their psychological status and quality of life during clinical diagnosis and treatment.The Nomogram model for the early diagnosis of anxiety and depression in MHD patients was established to provide a new way for the early recognition and early intervention of mental disorders in MHD patients.MethodsWe collected 500 patients with maintenance hemodialysis in the blood purification centers of Affiliated Hospital of Qingdao University from 2020.09 to 2020.10,collected clinical and socio-demographic data of patients,and investigated the prevalence of anxiety and depression in MHD patients.The clinical and socio-demographic indicators of MHD patients were described and counted by independent sample t-test or chi-square test.The patients were divided into anxiety group,non-anxiety group,depression group and non-depression group according to whether there was anxiety or depression,and the socio-demographic and clinical characteristics of patients in different groups were compared and analyzed.According to the method of random grouping,they were divided into training set(n=400,including 64 cases in anxiety group,336 cases in non-anxiety group,152 cases in depression group,248 cases in non-depression group)and verification set(n=100,including 17 cases in anxiety group,83 cases in non-anxiety group,31 cases in depression group,69 cases in non-depression group).Single factor and multiple factor logistic regression were used to analyze the risk factors related to anxiety and depression in the training center.According to the health-related quality of life scale(SF-12),the current situation of the quality of life of 500 MHD patients in this study was investigated.The independent sample t-test was used to carry out comparative analysis between different anxiety and depression groups,adjust potential confounding factors,and carry out correlation analysis between different anxiety and depression groups and quality of life.Suicide risk assessment scale(NGASR)was used to assess the suicide risk of patients in different depression groups,and the difference of suicide risk among different depression groups was analyzed by chi-square test.Based on the relevant risk factors of anxiety and depression obtained from the multifactor logistic regression analysis in the training set,the Nomogram model for the diagnosis of anxiety and depression in maintenance hemodialysis patients was established,and the model was applied to the validation set population for model validation,and the discrimination of the model was evaluated by the subject work characteristic curve(ROC).Results1.Anxiety,depression: 1329 MHD patients were included in this study,232 of whom were anxiety patients,with a prevalence rate of 17.5%.There were 339 patients with depression,the prevalence rate was 25.5%.Correlation analysis of anxiety: In this study,the results of multifactor analysis showed that the existence of anxiety state in MHD patients was independently related to the nature of work,the annual income of the family,whether they were accompanied by family members during dialysis,whether they had bad habits of smoking or drinking,and the history of chronic kidney disease.Compared with patients in the non-anxiety group,MHD patients in the anxiety group had a higher proportion of unemployed status(30.9% vs 20.3%,P<0.05),a higher annual income of families(8.67 ± 3.40 vs 7.02 ± 4.18,P<0.05),a longer history of chronic kidney disease(8.79 ± 5.75 vs 6.83 ± 4.99,P<0.05),and a higher proportion of family accompanying during dialysis(66.7% vs 38.7%,P<0.001),The proportion of bad behaviors and habits of smoking or drinking was higher(32.1% vs 9.3%,P<0.001).Correlation analysis of depression: The general data and clinical characteristics of MHD patients were analyzed by multivariate logistic regression,and it was found that the patient’s education level,family annual income,bad behavior habits of smoking or drinking,and the time of chronic kidney disease history were independently related to the occurrence of depression.The education level of the patients in the depression group was significantly lower than that in the non-depression group(63.2% vs 48.9%,P<0.01),the average annual income of the family was significantly higher than that in the non-depression group(8.241 ± 3.823 vs 6.732 ± 4.163,P<0.001),and the proportion of bad behaviors and habits of smoking or drinking was significantly higher than that in the non-depression group(19.7% vs 9.1%,P<0.01),The previous history of chronic kidney disease was significantly longer than that of non-depression group(8.08 ± 5.34 vs 6.606 ± 4.988,P<0.01).2.Quality of life and suicide risk: There is a significant correlation between anxiety state and quality of life of MHD patients.A comparative analysis of the quality of life of different anxiety groups showed that there were significant differences between the two groups in terms of physical related quality of life(PCS)(t=3.354,p=0.001<0.05)and psychological related quality of life(MCS)(t=7.012,p=0.000<0.05).After adjusting the possible confounding factors of anxiety and depression controlling the family’s annual income(10000),whether the family was accompanied during dialysis,whether smoking or drinking,and the number of years of chronic kidney disease,the partial correlation analysis was conducted.It was found that the correlation between anxiety depression and PCS and MCS was still significant.Correlation analysis of depression and suicide risk:there is no significant difference in suicide risk among different depression groups3.Nomogram diagnostic model: Anxiety Nomogram diagnostic model: Multivariate logistic regression showed that the patient’s work nature(OR=0.408,95% CI 0.183～0.911,P=0.029),annual income of the family(OR=2.889,95% CI 1.198～6.968,P=0.018),whether there was a family companion during dialysis(OR=0.44,95% CI 0.23～0.844,P=0.013),whether there were bad habits of smoking or drinking(OR=0.225,95% CI0.107～0.476,P<0.001)The history of chronic kidney disease(OR=3.086,95% CI1.165～8.177,P<0.05)was related to the diagnosis of anxiety in MHD patients.The Nomogram diagnostic model of anxiety was built based on the above factors,and the area under the ROC curve was 0.873.Nomogram diagnostic model of depression: Multivariate regression showed that education level(OR=0.526,95% CI 0.305～0.907,P=0.021),annual income of family(OR=2.273,95% CI 1.175～4.398,P=0.015),bad behavior habits of smoking or drinking(OR=2.273,95% CI 1.175～4.398,P=0.015),and history time of chronic kidney disease(OR=2.231,95% CI 1.048～4.749,P=0.037)were related to the diagnosis of depression,From this,the Nomogram diagnostic model is constructed and applied to the validation set,0.815 under the ROC curve.Conclusions(1)In this study,there were 232 patients with MHD anxiety,the prevalence rate was17.5%.There were 339 patients with depression,the prevalence rate was 25.5%.The existence of anxiety state in MHD patients is independently related to the nature of their work,the average annual income of their families,whether they are accompanied by family members during dialysis,whether they have bad habits of smoking or drinking,and the duration of their history of chronic kidney disease.MHD patients’ education level,family per capita annual income,bad habits of smoking or drinking,and history of chronic kidney disease were independently related to depression.(2)There was a significant correlation between the anxiety and depression state of MHD patients and their quality of life.There was no significant difference in suicide risk among different depression groups.(3)The Nomogram prediction model of MHD patients is constructed based on multiple socio-demographic and clinical characteristics of patients,which has high accuracy and clinical practicability,and is helpful to improve the attention of MHD patients’ psychological status,facilitate early diagnosis,early intervention,and improve the quality of life of patients. |
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