Depression, inactivity from kidney failure linked to unemployment

From PsychCentral:

A large number of people with kidney failure who were actively employed one year prior to beginning dialysis treatments are no longer working early in the first year of treatment.

In fact, about two thirds of end-stage renal disease (ESRD) dialysis patients who were working before dialysis leave the labor force when they begin treatment, according to a new study by an Emory University researcher and her team.

The study, headed by Nancy Kutner, PhD, professor of rehabilitation medicine and sociology at Emory University, reveals that both depression and less physical activity may play a major role in patients with kidney failure leaving the workforce.

Specifically, researchers found that in 585 ESRD dialysis patients who had worked the previous year, only 32.6 percent (191 patients) continued working after beginning dialysis treatment.

In patients who continued to work, only 12.1 percent had possible or probable depression – compared with 32.8 percent of patients who were no longer employed. Furthermore, patients who reported having higher levels of physical activity in the questionnaire were more likely to continue working.

Employment plays an important role in a person’s self-esteem, and most dialysis patients report that they would like to work.

“More attention to improving mood disorders and increasing usual activity levels among kidney disease patients might help them to maintain employment and would undoubtedly contribute to overall improvements in patients’ quality of life,” says Kutner.

“It is well established that depressed mood and inactivity are prevalent among patients on dialysis, but no previous studies in the U.S. have examined the associations of these variables with patients’ employment status,” says Kutner.

“Controlling for receipt of disability income, we found that patients with depressed mood and those with reduced activity levels were significantly more likely to leave the labor market when they started dialysis.”

Kutner adds that when the Medicare ESRD Program was started in 1972, Congress believed that most dialysis patients would be well enough to continue working and contributing to society, with the rest being able to go back to work after getting vocational rehabilitation help. Availability of Social Security disability income is a potential disincentive, although most people can earn far more by working than they would receive from disability.

“Both depressed mood and usual activity level are variables for which simple screening measures are available. Depressed mood and low activity can be addressed with interventions prior to, as well as after, dialysis start, and prior research shows that improvement in each of these areas is likely to also improve the other,” says Kutner.

The findings of this study are published online in the Clinical Journal of the American Society of Nephrology.