Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study

Schick‐Makaroff, Kara; Wozniak, Lisa; Short, H. D.; Klarenbach, Scott; Buzinski, Robert; Walsh, Michael; Johnson, Jeffrey

doi:10.1186/s41687-021-00385-z

Cited by 11 publications

(19 citation statements)

References 52 publications

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“…But Albertans in a different study investigating use of patient-reported outcomes in in-center dialysis also voiced their concerns about privacy for chairside mental health support. 20 Patients’ perspectives spanned the spectrum from feeling like they needed a private environment to feeling like all manner of their health was already discussed in a non-private environment, so why should mental health be any different? Nurse participants in this study held similar views spanning this continuum.…”

Section: Discussionmentioning

confidence: 99%

“… 1 The most common mental health symptoms reported by people receiving dialysis are depression and anxiety (40% 2 and 11%-52% 1 ), significantly higher than 5% and 3%, respectively, reported by all Canadians. 3 Mental health symptoms are underdiagnosed and undertreated among Canadians on dialysis and deserve attention; 4 - 7 the need for support is now greater.…”

Section: Introductionmentioning

confidence: 99%

“… 4 - 6 While clinicians may be reluctant to prescribe antidepressants due to inconclusive medication trials, 9 kidney function affecting effectiveness, and medication contraindications, 4 , 9 - 11 people receiving dialysis are also reluctant to take antidepressants due to side effects, medication interactions, or stigma. 4 , 9 But pharmaceutical interventions are only one form of potential support; psychosocial interventions may be more preferable, 9 with cognitive-behavioral therapy supported with the strongest evidence of efficacy and effectiveness. 12 , 13 Anxiety often coexists with depression for people receiving dialysis treatment.…”

Section: Introductionmentioning

confidence: 99%

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How Are Albertans “Adjusting to and Coping With” Dialysis? A Cross-Sectional Survey

Schick‐Makaroff

Berendonk

Overwater

et al. 2022

Can J Kidney Health Dis

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Background: Depression and anxiety are commonly reported (40% and 11%-52%) among adults receiving dialysis, compared with ~10% among all Canadians. Mental health in dialysis care is underrecognized and undertreated. Objective: (1) To describe preferences for mental health support reported by Albertans receiving dialysis; (2) to compare depression, anxiety, and quality-of-life (QOL) domains for people who would or would not engage in support for mental health; and (3) to explore sociodemographic, mental health, and QOL domains that explain whether people would or would not engage in support for mental health. Design: A cross-sectional survey. Setting: Alberta, Canada. Patients: Adults receiving all modalities of dialysis (N = 2972). Measurements: An online survey with questions about preferences for mental health support and patient-reported outcome measures (Patient Health Questionnaire–9 [PHQ-9], Generalized Anxiety Disorder–7 [GAD-7], and Kidney Disease QOL Instrument–36 [KDQOL-36]). Methods: To address objectives 1 and 2, we conducted chi-square tests (for discrete variables) and t tests (for continuous variables) to compare the distributions of the above measures for two groups: Albertans receiving dialysis who would engage or would not engage in support for mental health. We subsequently conducted a series of binary logistic regressions guided by the purposeful variable selection approach to identify a subset of the most relevant explanatory variables for determining whether or not people are more likely to engage in support for mental health (objective 3). To further explain differences between the two groups, we analyzed open-text comments following a summative content analysis approach. Results: Among 384 respondents, 72 did not provide a dialysis modality or answer the PHQ-9. The final data set included responses from 312 participants. Of these, 59.6% would consider engaging in support, including discussing medication with a family doctor (72.1%) or nephrologist (62.9%), peer support groups (64.9%), and talk therapy (60%). Phone was slightly favored (73%) over in person at dialysis (67.6%), outpatient (67.2%), or video (59.4%). Moderate to severe depressive symptoms (PHQ-9 score ≥10) was reported by 33.4%, and most respondents (63.9%) reported minimal anxiety symptoms; 36.1% reported mild to severe anxiety symptoms (GAD-7 score ≥5). The mean (SD) PHQ-9 score was 8.9 (6.4) for those who would engage in support, and lower at 5.8 (4.8) for those who would not. The mean (SD) GAD-7 score was 5.2 (5.6) for those who would engage in support and 2.8 (4.1) for those who would not. In the final logistic regression model, people who were unable to work had 2 times the odds of engaging in support than people who are able to work. People were also more likely to engage in support if they had been on dialysis for fewer years and had lower (worse) mental health scores (odds ratios = 1.06 and 1.38, respectively). The final model explained 15.5% (Nagelkerke R2) of the variance and with 66.6% correct classification. We analyzed 146 comments in response to the question, “Is there anything else you like to tell us.” The top 2 categories for both groups were QOL and impact of dialysis environment. The third category differed: those who would engage wrote about support, whereas those who would not engage wrote about “dialysis is the least of my worries.” Limitations: A low response rate of 12.9% limits representativeness; people who chose not to participate may have different experiences of mental health. Conclusions: Incorporating patients’ preferences and willingness to engage in support for mental health will inform future visioning for person-centered mental health care in dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How Are Albertans “Adjusting to and Coping With” Dialysis? A Cross-Sectional Survey

Schick‐Makaroff

Berendonk

Overwater

et al. 2022

Can J Kidney Health Dis

Self Cite

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“…It was concluded that PROMs (ESAS-r: Renal/EQ-5D-5L) had the potential to rapidly identify mental health problems. However, there were differing opinions on whether mental health fell within the scope of care of nephrologists and nurses, and there was consensus that more mental health resources were needed [31].…”

Section: Epros In Hemodialysis An Unfinished Businessmentioning

confidence: 99%

Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis

Pérez-Morales

Fuster

Esteve-Simó

et al. 2022

JCM

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The success of hemodialysis (HD) treatments has been evaluated using objective measures of analytical parameters, or machine-measured parameters, despite having available validated instruments that assess patient perspective. There is an emerging interest regarding the use and relevance of patient-related outcomes (PROs). Electronic PROs (ePROs) involve the use of electronic technology, provide rapid access to this information, and are becoming more widely used in clinical trials and studies to evaluate efficacy and safety. Despite the scarce literature, this review suggests that ePROs are useful in providing a more customized and multidimensional approach to patient management and in making better clinical decisions in relevant aspects such as vascular access, duration and frequency of dialysis sessions, treatment of anemia, mental health, fatigue, and quality of life. The purpose of this review is to raise interest in the systematic use of ePROs in HD and to promote the development of studies in this field, which can respond to the gaps in knowledge and contribute to the implementation of the use of ePROs through new technologies, helping to improve the quality of health care.

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“… 24 Furthermore, when the Can-SOLVE CKD Triple I Project identified the top 10 challenges to in-center hemodialysis care, people treated with hemodialysis believed that access to mental health care was a priority challenge to address. 25 However, stigma, siloed care designated by body parts (eg, kidney), dialysis culture, and concerns by providers about scope of practice 24 , 26 have all contributed to this pervasive, multifaceted health service gap. In turn, mental health care of adults treated with dialysis in Canada has been largely unexplored and unaddressed.…”

Section: Introductionmentioning

confidence: 99%

Mental Health Care for Adults Treated With Dialysis in Canada: A Scoping Review

Fernandez¹,

Thompson

Berendonk³

et al. 2022

Can J Kidney Health Dis

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Purpose of review: Mental illnesses, especially depression and anxiety, are common conditions frequently underrecognized and untreated among individuals with end-stage kidney disease. Existing tools/interventions, approaches to care, and resources to support mental health for people treated with dialysis in Canada are not well known. The aim of this scoping review was to systematically describe how mental health care is provided to adults treated with dialysis in Canada. The research questions we sought to answer were the following: (1) What mental health assessment tools and interventions for adults treated with dialysis have been investigated and utilized in Canada? (2) what is the structure and process of mental health care delivered by kidney care to adults treated with dialysis in Canada? and (3) what is the availability of mental health care resources developed for adults treated with dialysis in Canada? Sources of information: Electronic databases included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science for peer-reviewed literature, and Google search engine for gray literature. Methods: Systematic searches were conducted to identify peer-reviewed and gray literature that focused on mental health care or support offered to adults receiving any form of dialysis in Canadian kidney care settings and/or community organizations. Mental health care and support was defined to include mental health assessment tools, interventions, resources, guidelines, and/or pathways used in dialysis in Canada. Title, abstracts, and full texts were screened independently by 2 reviewers with discrepancies resolved by additional team members. Web sites were screened by individual members. Data from included studies and Web sites were extracted based on the abovementioned research questions. Key findings: We identified 8 peer-reviewed articles from electronic databases, and 28 separate Web site addresses. Of the 8 articles, 4 investigated mental health assessment tools and 4 examined mental health interventions for individuals treated with dialysis in Canada. The mental health assessment tools that have been used are Beck Depression Inventory-II (BDI-II), Edmonton System Assessment Scale (ESAS), Edmonton System Assessment Scale revised (ESAS-r): Renal, Hospital Anxiety and Depression Scale (HADS), and Distress Assessment and Response Tool (DART), and the nonpharmacological interventions that have been investigated are intradialytic exercise, tai chi exercise program, medical music therapy, and brief mindfulness meditation. Of the 28 Web site addresses, 2 contained clinical tools for kidney care providers for the management of depression and anxiety in individuals treated with dialysis. The 26 remaining Web sites contained mental health resources for individuals with kidney disease, which presented different types of resources, including psychoeducation, peer support, and linkage to other services. Conclusion: In conclusion, we found only a limited number of studies investigating mental health assessment tools and interventions in Canada; there was a paucity of randomized controlled trials. Clinical pathways for the assessment and management of mental illness or symptoms in individuals treated with dialysis in Canada are also limited, and no clinical practice guidelines exist. Several mental health resources for people living with dialysis are available, predominantly focused on psychoeducation and peer support. Despite increasing prevalence of mental health concerns by people treated with dialysis, mental health care remains underaddressed. Limitations: It is plausible that additional literature related to mental health assessment tools, interventions, resources, guidelines, and pathways exists that we did not find during our systematic search, especially in gray literature that was limited to one search engine. In addition, health care agencies or organizations may have developed other mental health resources, which may not be available on the Internet.

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Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study

Cited by 11 publications

References 52 publications

How Are Albertans “Adjusting to and Coping With” Dialysis? A Cross-Sectional Survey

How Are Albertans “Adjusting to and Coping With” Dialysis? A Cross-Sectional Survey

Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis

Mental Health Care for Adults Treated With Dialysis in Canada: A Scoping Review

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