S-363 : Relationship between Hwa-byung and Health Related Quality of Life in Korean Hemodialysis Patients

Background: Hwa-byung (HB), a Korean culture-bound syndrome, is caused by long-standing unfair social trauma and suppressed anger. HB has comparable comorbidity profile as major depression or generalized anxiety diorder. The aim was to investigate the prevalence of HB in Korean hemodialysis patients and its relationship between health-related quality of life (QoL) and other clinical characteristics. Methods: Clinically stable patients from 6 hemodialysis centers were enrolled. Thirty-six-item Short-Form Health Survey and temperament and symptom scale of HB, Hospital Anxiety and Depression Scale were used to diagnose and assess health-related QoL and psychological distress, respectively. Sociodemographic factors such as age, sex, education and hemodialysis-related clinical factors and laboratory parameters were assessed. Results: Two hundred and seventy one hemodialysis patients were enrolled and among them, 51 patients (18.9%) could be diagnosed with HB that is significantly more prevalent than that of general population (4.1%). The patient group with HB was less educated, more depressive and anxious and reported lower level of QoL than the patients without HB. The severities of HB and depressive symptoms were significantly associated not only with mental QoL but also with physical QoL in the final regression models. In contrast, anxiety symptom severity and other psychological variables were not associated with QoL. Of interest, C reactive protein level was negatively associated with both QoL levels of patients. Conclusions: After controlling multiple clinical variables, HB, depressive symptoms, and CRP level were significantly associated with mental and physical QoL. Chronic ongoing distress related to hemodialysis may contribute to increased prevalence of HB and depression in this patient group. Clinicians should be more attentive to emotional distress of hemodialysis patients to improve their health-related QoL.