Common Mental Disorders among Chronic Kidney Disease Out-Patients at Korle Bu Teaching Hospital

Abstract

Background: The association between chronic conditions such as Chronic Kidney Disease (CKD), and common mental disorders (CMD) or psychological distress has been well established in studies all over the world. This is however expected to be moderated given the presence of social support both from literature and practice. General Objective: The study aimed at determining the prevalence of CMD, identifying factors associated with increased levels of psychological distress, and determining the role of perceived social support in CKD outpatients at the Korle Bu Teaching Hospital. Methods: The design of the study was cross-sectional and employed quantitative data and statistical methods. The study site was the Korle-Bu Teaching Hospital, specifically the out-patient department and the renal unit of the medical block. A sample of 349 CKD outpatients, upon giving consent, was consecutively recruited into the study in June, 2019. The Kessler psychological distress scale (K10) and the Multidimensional Scale for Perceived Social Support scale were used to assess participants, including socio-demographic information and clinical data. Results: Using the Kessler (K10) scale, the prevalence of CMD is 67.91%. Again, it is expected that 25% of all patients seen within primary care will score above 20 on the K10, signifying presence of CMD. The proportion of respondents scoring 20 and over from the current study is far greater than this proposed proportion (z= 19.28, p<0.0001). The main predictors of CMD among CKD were Estimated Glomerular Filtrate Rate (eGFR) categories and whether or not an individual was on dialysis, with increased odds of CMD with respect to eGFR decline [Adjusted Odds Ratio = 0.998 (95% CI: 0.980 , 1.016), p< 0.01)] and CMD being more prevalent among patients on dialysis [Adjusted OR = 3.82 (95% CI: 1.29 , 11.32), p= 0.016)]. Discussion: There was a high prevalence of CMD among CKD outpatients. CMD or psychological distress, also declined with decrease in renal function. For outpatients on dialysis, dialysis was a major source of psychological distress. Perceived social support did not significantly affect the relationship between either renal function or dialysis status and psychological distress. Conclusion: CKD outpatients continue to be at an increased risk of major psychological ill-health as their kidney function further deteriorates. Further studies need to be done to explore issues concerning adjustment and resilience, in addition to the external social support that has been discussed as important in chronic disease management.