While looking at my calendar recently, I noticed World Mental Health Day was near. I began to think about the many dialysis patients we, as renal caregivers, see and how depression is such a prevalent issue among them. The lifestyle changes to be made during dialysis often bring up feelings of despair and loneliness for patients. They need a support team to help them get over this hurdle.

For today’s post, I asked Duane Dunn, MSW, national director of social work for DaVita, to give us a little insight into the issue of depression in dialysis patients, depression-treatment options and the teams that support this fragile population.

_____________________________________

October 10 is World Mental Health Day. This is a time when we reflect on the care and treatment of those individuals with mental-health needs as well as those who care for them. Particularly, I want to discuss dialysis patients, their interdisciplinary care teams and depression.

All patients have a very valuable resource available to them at their dialysis center: a clinic social worker. When I think of World Mental Health Day, the first thing that comes to mind is the demands that are put on dialysis patients. We social workers ask patients to show up on time; we inform patients what to eat and not to eat, how much they can drink and their length of treatment and the days of the week they will come for treatment. Our hearts are in the right place—we want patients to be as independent and healthy as possible—but these changes can be difficult.

That being said, it’s important to discuss the topic of depression. In my 30 years as a social worker, I’ve found that this is a serious issue many dialysis patients face. In fact, studies show that one in four dialysis patients are depressed. This depression can continue for a week, a few months or even years. The patient’s interdisciplinary care team needs to be involved in treating depression. Many times when thinking of the interdisciplinary care team, you may consider the role of social workers, nurses, dietitians and physicians. But the most important member of that team is the patient. Only the individual patients know how they feel, which makes them the most integral part of the healing process.

Depression in dialysis patients can be caused by various circumstances. For example, patients oftentimes decide to stop working when they learn they need dialysis. This can leave patients feeling unfulfilled, especially if they’ve had long careers. For this reason, it is important to speak about the benefits of working on dialysis, among other activities patients enjoyed before starting treatment. Patients with careers should speak with their social workers about how to continue working and about finding treatment options that fit their lives, their schedules. End stage renal disease (ESRD) patients who continue working, even while on dialysis, are 21 percent less likely to be depressed than those who quit working upon starting dialysis(1). Of course, everyone has different needs and it is best for patients to work with their interdisciplinary teams to determine what best fits their individual needs.

It can be hard to identify depression in dialysis patients. First, it takes the patients being comfortable talking with their social workers and expressing how they feel. Questions a social worker will ask include “How long have you been feeling this way?” and “Has this been going on for awhile?” The social worker can then engage the interdisciplinary care team. Social workers will look at the patients’ labs. They may ask patients to bring in current medications to do a med review. Additionally, a social worker may ask you to complete the Kidney Disease Quality of Life Instrument for a patient, which can indicate how the patient feels and functions daily. The interdisciplinary care team should complete an assessment, including the patient’s input, and then meet to come up with a complete plan of care. The social worker may refer a patient to community resources for assistance.

The effects of depression can truly impact a patient’s quality of life. It’s important for patients to know that social workers, and their entire care team, are here to listen and assist them in working through important life changes, including starting or ending treatments such as dialysis.

Depression can have many causes. In the case of someone who has just been diagnosed with chronic kidney disease, there may be a lot of physical-health information to process, which may lead to strong emotions about life and how it will change. Similarly, once a person reaches end stage renal disease and begins dialysis, the lifestyle adjustments that need to be made can bring up feelings of despair. Many times these feelings are temporary; however, it’s important to recognize when these feelings are not improving as time goes on. No one needs to be hesitant or embarrassed about getting the help they need to live the best quality of life possible.

Depression is very treatable. Just like a patient gets medical treatment for renal disease, there are treatments available for depression.

Duane Dunn, MSW, national director of social work; DaVita
Duane has been a social worker for 30 years. He started his career in nephrology social work 20 years ago as a clinical social worker in South Florida. In his current role with DaVita, he works with more than 1600 DaVita Health Care Partner social workers across the US.

1. Kutner NG, Zhang R, Huang Y, Johansen KL. Depressed mood, usual activity level, and continued employment after starting dialysis.Clin J Am Soc Nephrol. 2010 Nov;5(11):2040-5. doi: 10.2215/CJN.03980510. Epub 2010 Sep 30.