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    Centers for Disease Control and Prevention. Youth Risk Behavior Survey. Data Summary & Trends Report: 2011–2021. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Chambers RA, et al. Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. Am J Psychiatry 2003; 160:10411052. doi: 10.1176/appi.ajp.160.6.1041

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Kogon AJ, et al. Depression and its associated factors in pediatric chronic kidney disease. Pediatr Nephrol 2013; 28:18551861. doi: 10.1007/s00467-013-2497-5

  • 4.

    Abdel Salam MM, et al. Assessment of depression and anxiety in children on regular hemodialysis. Egypt J Psychiatry 2014; 35:100104. doi: 10.4103/1110-1105.134196

  • 5.

    Amr M, et al. Multi-method assessment of behavior adjustment in children with chronic kidney disease. Pediatr Nephrol 2009; 24:341347. doi: 10.1007/s00467-008-1012-x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Neul SK, et al. Health-related quality of life functioning over a 2-year period in children with end-stage renal disease. Pediatr Nephrol 2013; 28:285293. doi: 10.1007/s00467-012-2313-7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Grootenhuis MA, et al. The impact of delayed development on the quality of life of adults with end-stage renal disease since childhood. Pediatr Nephrol 2006; 21:538544. doi: 10.1007/s00467-006-0030-9

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Wisk LE, Weitzman ER. Substance use patterns through early adulthood: Results for youth with and without chronic conditions. Am J Prev Med 2016; 51:3345. doi: 10.1016/j.amepre.2016.01.029

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Weitzman ER, et al. Alcohol use and alcohol-interactive medications among medically vulnerable youth. Pediatrics 2018; 142:e20174026. doi: 10.1542/peds.2017-4026

  • 10.

    DiMatteo MR, et al. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160:21012107. doi: 10.1001/archinte.160.14.2101

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Dobbels F, et al. Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review. Pediatr Transplant 2010; 14:603613. doi: 10.1111/j.1399-3046.2010.01299.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Zhang Y, et al. Child and caregiver perspectives on access to psychosocial and educational support in pediatric chronic kidney disease: A focus group study. Pediatr Nephrol 2023; 38:249260. doi: 10.1007/s00467-022-05551-z

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Dawson AE, et al. Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey. PLoS One 2023; 18:e0285126. doi: 10.1371/journal.pone.0285126

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Supporting the Mental Health Needs of Adolescents and Young Adults With Kidney Diseases

Carlos Cesar Becerril Romero Carlos Cesar Becerril Romero, MD, is a pediatric nephrologist in training at the Ann & Robert H. Lurie Children's Hospital of Chicago, IL, and a double kidney transplant recipient.

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When the Centers for Disease Control and Prevention published the latest results of the Youth Risk Behavior Survey 1 year ago, it raised alarms about the mental well-being of adolescents and young adults (AYA) in the United States. The data showed that 42% of adolescents “experienced persistent feelings of sadness or hopelessness,” a significant increase from 28% in 2011 (1).

As pediatric nephrologists, we care for AYA with a chronic illness, including during periods of added vulnerability when they are transitioning care. Their developmental stage (2), combined with the burden of a chronic disease, may increase their susceptibility to mental health disorders. AYA with chronic kidney disease (CKD), on dialysis, or with a kidney transplant experience even higher rates of depression and anxiety compared with their healthy counterparts (37). AYA with chronic diseases are also engaging in more substance use, including alcohol, tobacco, or marijuana, compared with AYA without a chronic illness (8). Our patients are struggling, and we must do more to help them.

Mental health disorders may exacerbate the risks of medical complications, leading to worse health outcomes. For example, depression, anxiety, and substance use are associated with medical treatment nonadherence (9, 10). Medication nonadherence among patients who have received transplants can lead to allograft rejection and graft failure (11). Addressing the psychosocial needs of our patients may help improve their long-term survival.

In addition, patients are yearning for additional support to cope during their medical journey. Zhang and colleagues (12) studied the experiences of patients aged 8–21 years with CKD stages 1–5. The study identified that patients felt disadvantaged by the disruption to their self-esteem and identity, bearing the burden alone, and being unable to access psychologic support. Providing psychosocial support to our patients may improve their medical experience and quality of life.

Pediatric nephrologists are often the health care practitioners with whom AYA living with kidney diseases have the closest relationship. They are uniquely positioned to screen and identify patients experiencing mental health issues. When Dawson et al. (13) asked pediatric nephrologists about the importance of providing psychosocial support in their nephrology division, 80% of practitioners across all centers indicated that it was “important” or “very important” to provide holistic care. However, pediatric nephrologists may assume that mental health screening occurs in the primary care setting. In addition, there is a pediatric nephrology workforce crisis, and practitioners are already stretched thin helping patients. Asking pediatric nephrologists also to address the mental health needs of their patients may seem burdensome, out of scope, and unrealistic.

What we can do as pediatric nephrologists is recognize mental health support as treatment to improve kidney health. By including and working with our multidisciplinary team (i.e., social workers, nurses, and child life specialists), we can maximize efforts to support patients and families. We need to screen AYA with CKD regularly for early identification of psychosocial issues that may impact their care. We need to have dedicated psychosocial professionals who can support the most vulnerable patients undergoing nephrology care.

Addressing the mental health needs of patients is no easy task. Clinicians may feel uncomfortable discussing mental health concerns, and the nephrology team may not have adequate resources to help their patients. Do not let this stop you from checking on your patients. Simply asking how they are coping can make a difference.

Footnotes

The author reports no conflicts of interest.

References

  • 1.

    Centers for Disease Control and Prevention. Youth Risk Behavior Survey. Data Summary & Trends Report: 2011–2021. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Chambers RA, et al. Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. Am J Psychiatry 2003; 160:10411052. doi: 10.1176/appi.ajp.160.6.1041

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Kogon AJ, et al. Depression and its associated factors in pediatric chronic kidney disease. Pediatr Nephrol 2013; 28:18551861. doi: 10.1007/s00467-013-2497-5

  • 4.

    Abdel Salam MM, et al. Assessment of depression and anxiety in children on regular hemodialysis. Egypt J Psychiatry 2014; 35:100104. doi: 10.4103/1110-1105.134196

  • 5.

    Amr M, et al. Multi-method assessment of behavior adjustment in children with chronic kidney disease. Pediatr Nephrol 2009; 24:341347. doi: 10.1007/s00467-008-1012-x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Neul SK, et al. Health-related quality of life functioning over a 2-year period in children with end-stage renal disease. Pediatr Nephrol 2013; 28:285293. doi: 10.1007/s00467-012-2313-7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Grootenhuis MA, et al. The impact of delayed development on the quality of life of adults with end-stage renal disease since childhood. Pediatr Nephrol 2006; 21:538544. doi: 10.1007/s00467-006-0030-9

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Wisk LE, Weitzman ER. Substance use patterns through early adulthood: Results for youth with and without chronic conditions. Am J Prev Med 2016; 51:3345. doi: 10.1016/j.amepre.2016.01.029

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Weitzman ER, et al. Alcohol use and alcohol-interactive medications among medically vulnerable youth. Pediatrics 2018; 142:e20174026. doi: 10.1542/peds.2017-4026

  • 10.

    DiMatteo MR, et al. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000; 160:21012107. doi: 10.1001/archinte.160.14.2101

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Dobbels F, et al. Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: A systematic review. Pediatr Transplant 2010; 14:603613. doi: 10.1111/j.1399-3046.2010.01299.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Zhang Y, et al. Child and caregiver perspectives on access to psychosocial and educational support in pediatric chronic kidney disease: A focus group study. Pediatr Nephrol 2023; 38:249260. doi: 10.1007/s00467-022-05551-z

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Dawson AE, et al. Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey. PLoS One 2023; 18:e0285126. doi: 10.1371/journal.pone.0285126

    • PubMed
    • Search Google Scholar
    • Export Citation
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