Article The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Background and objectives Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality. Design, setting, participants, & measurements This study examined the association of changes in mental health over time with all-cause and cause-specific deaths and cardiac hospitalizations in the Hemodialysis study patients. Mental health was assessed at baseline and annually during the study with short form 36 mental health index scores. Poorer mental health was defined by a mental health index score#60. Results Patients with poorer mental health at baseline were more likely to have less than a high school education and be unmarried, have significantly higher index of coexistent disease scores, and report taking b-blockers and sleepmedications. Lowmental health scores over timewere independently associatedwith a decrease in survival time from all-cause mortality by20.06 (20.10,20.03; P,0.001), and they also significantly hastened time to first cardiac hospitalization by20.08 (20.13,20.02; P=0.01) and composite of first cardiac hospitalization or cardiac death by 20.04 (20.07, 20.02; P,0.001). Conclusions This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention tomental health related to cardiac complications and even death in dialysis patients