News Release: Research , School of Medicine

Oct. 1,  2010

Study Finds Depression and Inactivity May Lead to Higher Unemployment for Dialysis Patients

News Article Image"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.

Many patients with kidney failure who were actively employed one year before beginning dialysis treatments are no longer employed early in their first year of treatment according to a recent study by an Emory University researcher and her colleagues.

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.

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.

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