Psychiatric Diagnoses in Children With CKD Compared to the General Population
Jessica L Stahl1,2, Aaron G Wightman3,4, Jennifer E Flythe1,2
1Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, University of North Carolina Kidney Center, Chapel Hill, NC.
Insights
Children with chronic kidney disease (CKD) have higher rates of depression and lower rates of anxiety diagnoses compared to the general population. Current assessments may not fully capture psychiatric disorders in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Child Psychiatry
- Epidemiology
Background:
- Children with chronic kidney disease (CKD) face unique physical and psychosocial challenges.
- These challenges may increase their risk for developing psychiatric disorders.
- Understanding psychiatric diagnoses in pediatric CKD is crucial for comprehensive care.
Purpose of the Study:
- To compare key psychiatric diagnoses in children with CKD versus the general pediatric population.
- To assess the correlation between parent-reported diagnoses and self-reported depression symptoms.
- To identify potential disparities in mental health diagnoses among children with CKD.
Main Methods:
- Cross-sectional study comparing children in the Chronic Kidney Disease in Children Study (CKiD) with the National Survey of Children's Health.
- Used Poisson regression to determine adjusted prevalence ratios for depression, anxiety, and ADHD.
- Examined correlation between parent-reported diagnoses and self-reported depression screening scores.
Main Results:
- Children with CKD showed a higher prevalence of parent-reported depression (PR 1.32) and lower anxiety (PR 0.72) compared to controls.
- Prevalence of ADHD was similar between groups (PR 1.03).
- Correlation between parent-reported depression and screening instruments was weak (r=0.13).
Conclusions:
- Children with CKD exhibit a higher prevalence of depression and lower prevalence of anxiety diagnoses.
- Findings suggest current baseline assessments may have limited utility for psychiatric disorders in pediatric CKD.
- There is a need for improved mental health assessment strategies in pediatric nephrology.
Rationale & Objective:
Children with chronic kidney disease (CKD) are subject to physical and psychosocial challenges, which may confer greater risk of developing psychiatric disorders. We sought to examine key psychiatric diagnoses in children with CKD compared with those in the general pediatric population and assess the correlation between parent-reported diagnosis and self-reported symptoms of depression.
Study Design:
Cross-sectional.
Setting & Participants:
Children ages 2-17 years receiving current medical care who participated in the Chronic Kidney Disease in Children Study (CKiD) or the National Survey of Children's Health.
Exposure:
CKD.
Outcomes:
Parent-reported diagnoses of depression, anxiety, or attention-deficit and hyperactivity disorder (ADHD).
Analytical Approach:
Using Poisson regression, we determined the age, sex, and race-adjusted prevalence ratio comparing diagnoses between children with CKD and those in the general population overall and within subgroups of sex, race, maternal education status, and CKD stage. Secondarily, we examined the correlation between depression status using standardized self-reported screening instrument scores and parent-reported diagnosis.
Results:
Eight hundred seventy-five children with CKD and 72,699 children in the general population were included. Those with CKD had an adjusted prevalence ratio of 1.32 (95% CI, 1.01-1.73) for depression, 0.72 (95% CI, 0.52-0.99) for anxiety, and 1.03 (95% CI, 0.86-1.25) for ADHD. The results were similar across subgroups of CKD stage, sex, race, or maternal education. The correlation between parent-reported diagnosis and instrument-detected depression was weak, r = 0.13 (95% CI, 0.03-0.23).
Limitations:
Retrospective parent- or self-reported data were used.
Conclusions:
Children with CKD had a higher prevalence of parent-reported depression, equivalent prevalence of attention-deficit and hyperactivity disorder, and lower prevalence of anxiety diagnoses compared to other children. These findings are inconsistent with results of prior studies and suggest that baseline assessments used in CKiD may have limited utility in describing psychiatric disorders among children with CKD. Improved mental health assessment approaches in pediatric nephrology are needed.
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