Cardol Cinderella K, Meuleman Yvette, van Middendorp Henriët, van der Boog Paul J M, Hilbrands Luuk B, Navis Gerjan, Sijpkens Yvo W J, Sont Jacob K, Evers Andrea W M, van Dijk Sandra
Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Kidney Med. 2023 Aug 11;5(10):100712. doi: 10.1016/j.xkme.2023.100712. eCollection 2023 Oct.
RATIONALE & OBJECTIVE: Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations.
Cross-sectional online questionnaire data as part of the E-GOAL study.
SETTING & PARTICIPANTS: Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires.
Psychological distress, depressive symptoms, and anxiety symptoms.
Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors).
Adjusted multivariable regression and ordinal logistic regression analyses.
In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (β, -0.13; 95% CI, -0.23 to -0.04), less physical activity (β, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (β, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07).
Cross-sectional design, possible residual confounding, and self-report.
Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management.
PLAIN-LANGUAGE SUMMARY: This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.
未接受透析的慢性肾脏病（CKD）患者，包括肾移植受者，在自我管理方面常常面临困难。心理困扰（包括抑郁和焦虑症状）可能是妨碍遵循自我管理建议的一个重要障碍。我们研究了心理困扰与遵循自我管理建议之间的关系。
作为E-GOAL研究一部分的横断面在线问卷调查数据。
2018年4月至2020年10月期间，在荷兰的4家医院招募了估算肾小球滤过率为20 - 89 mL/min/1.73 m²的CKD患者，并让他们完成在线筛查问卷。
心理困扰、抑郁症状和焦虑症状。
饮食依从性、身体活动、药物依从性、吸烟情况、体重指数以及CKD自我管理指数（即不遵循推荐的自我管理因素的5个二元指标之和）。
调整后的多变量回归和有序逻辑回归分析。
在我们的样本（N = 460）中，27.2%的患者报告有心理困扰，69.8%的患者不遵循1条或更多建议。更高程度的心理困扰与较差的饮食依从性（β， -0.13；95%置信区间，-0.23至 -0.04）、较少的身体活动（β， -0.13；95%置信区间，-0.22至 -0.03）以及较低的药物依从性（β， -0.15；95%置信区间，-0.24至 -0.05）显著相关，但与吸烟情况和体重指数无关。抑郁症状的结果相似，而焦虑仅与较差的饮食和药物依从性相关。心理困扰每增加1分，不遵循越来越多不同建议的可能性也更高（调整后的比值比，1.04；95%置信区间，1.02 - 1.07）。
横断面设计、可能存在残余混杂因素以及自我报告。
许多CKD患者存在心理困扰，其中大多数人在CKD自我管理方面存在困难。鉴于心理困扰与遵循CKD自我管理建议之间的关系，需要采取行为干预措施来识别和治疗心理困扰，将其作为CKD自我管理的潜在障碍。
这项在线问卷调查研究调查了460名慢性肾脏病患者的心理困扰与自我管理之间的关系。超过四分之一的患者报告有轻度至重度心理困扰。令人担忧的是，五分之四的有心理困扰的患者也不遵循1条或更多自我管理建议，并且心理困扰程度越高，饮食和药物依从性越差，身体活动越少。此外，与没有或有轻度困扰症状的患者相比，患有中度至重度困扰的患者相对更常不遵循3条或更多建议。所以，心理困扰似乎可能是自我管理的一个障碍。为了帮助患者管理慢性肾脏病，研究人员和健康专业人员不应忽视患者的心理健康。
