According to a study authored by Nancy Kutner, PhD, professor of rehabilitation medicine and sociology at Emory University, depression and reduced physical activity may play a key role in dialysis patients leaving the ranks of the employed. The findings are published online in the Clinical Journal of the American Society of Nephrology.
“More attention to improving mood disorders and increasing usual activity levels among kidney disease patients might help them to maintain employment and would undoubtedly contribute to overall improvements in patients’ quality of life,” says Nancy Kutner, PhD.
Among 585 End Stage Renal Disease (ESRD) dialysis patients who had worked in the previous year, only 191 (32.6 percent) continued working after initiating dialysis. The study revealed that only 12.1 percent of patients who remained employed had possible or probable depression – compared with 32.8 percent of patients who were no longer employed. In addition, patients who scored higher on questions related to their level of physical activity were more likely to continue working.
“More attention to improving mood disorders and increasing usual activity levels among kidney disease patients might help them to maintain employment and would undoubtedly contribute to overall improvements in patients’ quality of life,” says Kutner.
When the Medicare ESRD Program was established in 1972, Congress expected that most dialysis patients would be able to continue working and contributing to society, with the remainder being able to return to work after receiving vocational rehabilitation services, according to Kutner. Employment is important for an individual’s self-esteem, and most patients say that they would like to work. About two-thirds of ESRD patients who are employed prior to dialysis leave the labor force when they start dialysis, however. Availability of Social Security disability income is a potential disincentive, although most people can earn much more by working than they would receive from disability.
“It is well established that depressed mood and inactivity are prevalent among patients on dialysis, but no previous studies in the U.S. have examined the associations of these variables with patients’ employment status,” says Kutner. “Controlling for receipt of disability income, we found that patients with depressed mood and those with reduced activity levels were significantly more likely to leave the labor market when they started dialysis. Both depressed mood and usual activity level are variables for which simple screening measures are available. Depressed mood and low activity can be addressed with interventions prior to, as well as after, dialysis start, and prior research shows that improvement in each of these areas is likely to also improve the other.”
The article is available online.
The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital. The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.