Depressed Mood, Usual Activity Level, and Continued Employment after Starting Dialysis

Abstract

Background and objectives: When patients start dialysis, their employment rate declines and disability benefits are an option. With patient sociodemographic and clinical characteristics including disability income status controlled, we investigated the significance of depressed mood and usual activity level as predictors of patients' continued employment after dialysis start.Design, setting, participants, & measurements: Incident patients from 296 randomly selected dialysis clinics were surveyed in the Comprehensive Dialysis Study (CDS). Participants provided information about employment status, disability income status, education, depressive symptoms measured by the Patient Health Questionnaire-2 (PHQ-2), and usual activity level/ energy expenditure measured by the Human Activity Profile. Age, gender, race, insurance, diabetes, inability to ambulate or transfer, chronic obstructive pulmonary disease, cardiovascular conditions, and hemoglobin and serum albumin values at treatment start were obtained from US Renal Data System files. Dialysis modality was defined at time of interview.Results: Among 585 CDS participants who worked in the previous year, 191 (32.6%) continued working after dialysis start. On the basis of the PHQ-2 cutoff score >3, 12.1% of patients who remained employed had possible or probable depression, compared with 32.8% of patients who were no longer employed. In adjusted analyses, higher Human Activity Profile scores were associated with increased likelihood of continued employment, and there was a borderline association between lower PHQ-2 scores and continued employment.Conclusions: Screening and management of depressive symptoms and support for increased activity level may facilitate patients' opportunity for continued employment after dialysis start, along with generally improving their overall quality of life.

Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients

“…Many possible factors infusing employment status were reported such as age, gender, education levels, lifestyle, dialysis modality, medical insurance, serum albumin, anemia, physical and psychological functioning, disease etiology(diabetes), availability of late-shift dialysis, training, and high-frequency hemodialysis [9,10,[17][18][19][20][21]. However, in our study, we observed that only increasing age, lower educational level, and higher annual income were identified as independent risk factors for loss of employment.…”

Factors associated with employment in patients undergoing hemodialysis: a mixed methods study

“…A relationship between decline of energy level and maintenance of employment after dialysis initiation has been observed [16]. Indeed, Kutner et al [17] reported that patients who remained employed had a lower score on the Patient Health Questionnaire 2 (PHQ-2) depression measure; on the basis of The rounded rectangles denote the categories generated from concepts by a grounded theory approach, and the ovals designate our interpretations the PHQ-2 cutoff score ≥3, 12.1% of the 191 patients who remained employed had possible or probable depression, compared with 32.8% of the 394 patients who were no longer employed.…”

Psychological and Social Aspects of Living with Chronic Kidney Disease

“…Our results also suggest that resignation from paid work further continues in the dialysis phase. Findings from a study conducted by Kutner et al (2010) also point to job resignation during the pre-dialysis phase and the initiation phase of dialysis treatment. Their study showed that, among 585 incident patients who were working for pay during the year before dialysis, only 191 (32.6%) continued working approximately 4 months after dialysis start.…”

“…However, patient-level characteristics were not taken into account, and due to the design of the study the associations observed between facility characteristics and patient employment could not be interpreted as cause-and-effect relationships. Another study by Kutner et al (2010) revealed that higher levels of energy expenditure reflected in usual activity levels were associated with increased likelihood of continued employment after dialysis start. The labour participation rate of 24% found in our study among Dutch dialysis patients of working age is considerably lower than that of the general Dutch population in the ages of 15-64 years, of which 65% were employed for at least 12 hours per week in 2006.…”