标题：Association of Posttraumatic Stress Disorder and Depression With All-Cause and Cardiovascular Disease Mortality and Hospitalization Among Hurricane Katrina Survivors With End-Stage Renal Disease
摘要：Objectives. We determined the association of psychiatric symptoms in the year after Hurricane Katrina with subsequent hospitalization and mortality in end-stage renal disease (ESRD) patients. Methods. A prospective cohort of ESRD patients (n = 391) treated at 9 hemodialysis centers in the New Orleans, Louisiana, area in the weeks before Hurricane Katrina were assessed for posttraumatic stress disorder (PTSD) and depression symptoms via telephone interview 9 to 15 months later. Two combined outcomes through August 2009 (maximum 3.5-year follow-up) were analyzed: (1) all-cause and (2) cardiovascular-related hospitalization and mortality. Results. Twenty-four percent of participants screened positive for PTSD and 46% for depression; 158 participants died (79 cardiovascular deaths), and 280 participants were hospitalized (167 for cardiovascular-related causes). Positive depression screening was associated with 33% higher risk of all-cause (hazard ratio [HR] = 1.33; 95% confidence interval [CI] = 1.06, 1.66) and cardiovascular-related hospitalization and mortality (HR = 1.33; 95% CI = 1.01, 1.76). PTSD was not significantly associated with either outcome. Conclusions. Depression in the year after Hurricane Katrina was associated with increased risk of hospitalization and mortality in ESRD patients, underscoring the long-term consequences of natural disasters for vulnerable populations. Hurricane Katrina made landfall on August 29, 2005 near New Orleans, Louisiana. The geographical features of the city, the limited social capital of a large proportion of the population, the incomplete evacuation of residents, and a delayed governmental response combined to make Hurricane Katrina the costliest, as well as one of the most protracted and deadly, natural disasters in US history. Individual residents of New Orleans reported separation from family, injury, exacerbation of illness, and exposure to dead bodies during and after Katrina. 1,2 This led to high rates of posttraumatic stress disorder (PTSD) and depression 3,4 that have been remarkably persistent in the years after the disaster. 5 Many residents were displaced for months or years, and a large portion of the population has never returned. Longitudinal research on Katrina survivors has proven exceedingly difficult because of the chaotic nature of the evacuation 1 and the broad dispersion of Katrina survivors. 6 Among the most vulnerable groups in a complex disaster such as Katrina are those who rely on continuity of medical care for survival, and among the most reliant on such treatment are hemodialysis patients. In a previous study, we found that 24% of hemodialysis patients who received treatment in New Orleans during the week before Katrina reported symptoms consistent with a diagnosis of PTSD a full year later. 6 Furthermore, 46% of hemodialysis patients reported symptoms consistent with a major depression disorder diagnosis. 7 Patients with end-stage renal disease (ESRD) receiving dialysis treatment have a very high risk of cardiovascular mortality. 8 Both PTSD and depression have been associated with increased risk of incident and recurrent cardiovascular events 9,10 and mortality 11 in prospective studies of veteran and general population samples, and a growing body of literature suggests that PTSD and depression are associated with poor prognosis in patients with established heart disease. 12–16 In ESRD patients on hemodialysis, both physician-diagnosed and self-reported depression have been associated with an increased risk of mortality and hospitalization. 17–19 However, data are limited on the association of PTSD to hospitalization or mortality in hemodialysis patients. Therefore, we tested whether PTSD and depression in the year after Hurricane Katrina were associated with subsequent all-cause and cardiovascular disease (CVD)-related mortality and hospitalization in a prospective cohort study of Katrina survivors on hemodialysis.
