National Estimates of Mental Health Needs Among Adults With Self-Reported CKD in the United States

Abstract

Introduction: Among adults with chronic kidney disease (CKD), comorbid mental illness is associated with poorer health outcomes and can impede access to transplantation. We provide the first US nationally representative estimates of the prevalence of mental illness and mental health (MH) treatment receipt among adults with self-reported CKD.

Methods: Using 2015 to 2019 National Survey on Drug Use and Health (NSDUH) data, we conducted an observational study of 152,069 adults (age ≥22 years) reporting CKD (n = 2544), with no reported chronic conditions (n = 117,235), or reporting hypertension (HTN) or diabetes mellitus (DM) but not CKD (HTN/DM, n = 32,290). We compared prevalence of (past-year) any mental illness, serious mental illness (SMI), MH treatment, and unmet MH care needs across the groups using logistic regression models.

Results: Approximately 26.6% of US adults reporting CKD also had mental illness, including 7.1% with SMI. When adjusting for individual characteristics, adults reporting CKD were 15.4 percentage points (PPs) and 7.3 PPs more likely than adults reporting no chronic conditions or HTN/DM to have any mental illness (P < 0.001) and 5.6 PPs (P < 0.001) and 2.2 PPs (P = 0.01) more likely to have SMI, respectively. Adults reporting CKD were also more likely to receive any MH treatment (21% vs. 12%, 18%, respectively) and to have unmet MH care needs (6% vs. 3%, 5%, respectively).

Conclusion: Mental illness is common among US adults reporting CKD. Enhanced management of MH needs could improve treatment outcomes and quality-of-life downstream.

Keywords: chronic kidney disease; mental health treatment; mental illness.

Graphical abstract

Figure 1

Predicted probabilities of any mental illness and SMI across U.S. adult groups, 2015 to 2019. Hypertension, diabetes, CKD, and other comorbid conditions identified using survey item: “Please read the list and type in the numbers of all of the conditions that a doctor or other health care professional has ever told you that you had.” Predicted probabilities, presented with 95% CIs, generated using the results of multivariable logistic regression models. Predisposing measures included respondent sex, age, and race/ethnicity. Enabling characteristics included health insurance status, family income, employment, education, and if the family received any governmental assistance. Need-related characteristics comprised self-rated health and indicators for chronic conditions and substance use behaviors. All models include year fixed effects. CKD, adults with chronic kidney disease; HTN/DM, adults with hypertension and/or diabetes but not chronic kidney disease; NCC, adults with no chronic condition identified; SMI, serious mental illness.

Figure 2

Predicted probabilities of MH treatment and unmet MH care needs across U.S. adult groups, 2015 to 2019. Hypertension, diabetes, CKD, and other comorbid conditions identified using survey item: “Please read the list and type in the numbers of all of the conditions that a doctor or other health care professional has ever told you that you had.” Predicted probabilities, presented with 95% CIs, generated using the results of multivariable logistic regression models. Predisposing measures included respondent sex, age, and race/ethnicity. Enabling characteristics included health insurance status, family income, employment, education, and if the family received any governmental assistance. Need-related characteristics comprised self-rated health and indicators for chronic conditions and substance use behaviors. All models include year fixed effects. CKD, adults with chronic kidney disease; HTN/DM, adults with hypertension and/or diabetes but not chronic kidney disease; MH, mental health; NCC, adults with no chronic condition identified.