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Improving Mental Health Care of Kidney
Disease Patients: A Call for Action
By Molly Phillips, MPH, MSW, Barry Smith, MD, PhD,
Pamela Hoyt-Hudson, BSN, RN, and Jennifer Melendez, BA,
CHC, CHRC, CIP (all from The Rogosin Institute)
The following article was submitted by the Rogosin Institute. It
highlights their work to meet both the physical and emotional
needs of their patients. Talk to your dialysis facility about the
resources that may be available to you.
In a recent conversation between a staff member at the Rogosin Institute and a dialysis patient in Brooklyn, the patient
shared that at 37, she had been on dialysis for over 15 years
after a diagnosis of nephrotic syndrome in her late teens.
Years ago, a family member donated a kidney. However, after
only two years, the transplant failed. In addition to telling the
staffer about how much she was struggling to stabilize her
blood pressure and how frustrated she was following multiple hospitalizations in the preceding two months, she shared
that she had recently lost her uncle to cancer, that she had to
move apartments and was unsure how she could afford the
move, and that she was fighting with her mother, among other
stressors.
This patient’s experience is a perfect reminder that we cannot possibly expect End Stage Renal Disease (ESRD) patients
to follow their complex healthcare plans if they are concerned
about rent, have little social support, or have other life stressors beyond their dialysis care. As healthcare providers, we must do a
better job at addressing the
socio-economic needs of
our patients by connecting them to resources
and organizations that
can help. We must also
recognize the many
factors that influence
adherence to treatment and provide more
comprehensive mental health care to our
patients. We must enhance opportunities for
communication and work with patients as partners. Depression, anxiety, and stress among dialysis patients are incredibly
prevalent, and as providers, we can – and should – do more
to support the whole person, including their mental and emotional health needs. Dialysis patients are not defined by dialysis or ESRD, but rather by everything that makes them unique
human beings, just like all of us.
Research suggests that over one third of hemodialysis patients experience clinical depression (Palmer et al, 2013), and
around half of patients experience anxiety (Cukor, 2008 and
Feroze, 2012). The Centers for Medicare and Medicaid Services recently acknowledged that depression is all too common
and ignored among ESRD patients. With this in mind, this year,
CMS is requiring dialysis units to screen patients for depression. But simply screening patients is not enough: we must
have adequate follow-up plans in place for patients who need
treatment and further support.
In recognition of the need to better address the mental health
needs of dialysis patients, in October 2015, the Jack J. Dreyfus
Center for Health Action and Policy (CHAP) at The Rogosin Institute convened a Roundtable discussion with experts in the
field of mental health, depression, and kidney disease entitled