Understanding the Association Between Mental Health and Medication Adherence in Adolescents with Chronic Kidney Disease
Description
Background
Adolescents with CKD often face significant mental health challenges that may affect their medication adherence. Despite the high prevalence of mental health concerns (specifically internalizing symptoms) in this population, the association between the severity of these symptoms and medication adherence remains underexplored.
Methods
The current cross-sectional study included adolescents with CKD who were prescribed an antihypertensive medication and completed the Behavior Assessment System for Children, 2nd edition Self-report (BASC-SRP-2). Antihypertensive medication adherence was objectively evaluated over 2 weeks using the MEMS cap. We used the BASC-SRP-2 depression, anxiety, somatization, and internalizing scales and classified participants into sub-clinical (T-score < 60) and at-risk (T-score ≥ 60) groups. We examined the associations between the selected BASC-SRP-2 domains and medication adherence using Wilcoxon rank-sum tests. Adjusted associations were evaluated with logistic regression models dichotomizing adherence as < 75% or ≥75% (covariates were age, race, sex, and income).
Results
The analyzed sample included 103 adolescents with CKD (M age = 15.4 years, SD = 2.44, 52% male, 44% White, 43% Black/African American, 14% Other; and (< $50,000: 38%, $50,000–$99,999: 27%, $100,000+: 35%) Table 1 provides information on the proportion of the sample at risk for elevated symptoms of the selected BASC-SRP domains. Medication adherence was significantly lower among adolescents with at-risk depression and internalizing problems compared to the sub-clinical group. Neither anxiety nor somatization were significantly associated with lower adherence. After adjusting for covariates, neither depression nor internalizing symptoms were significantly associated with adherence.
Conclusion
Adolescents with CKD may be at risk for high levels of mental health problems. When adolescents have At-risk levels of depression and internalizing problems, they may have significantly lower medication adherence compared to adolescents with subclinical symptoms. However, these associations were no longer significant after controlling for key demographic variables, which may be attributed to the smaller sample size. These results show the critical importance of addressing mental health problems in adolescents with CKD, which could improve adherence outcomes.
Understanding the Association Between Mental Health and Medication Adherence in Adolescents with Chronic Kidney Disease
Philadelphia, PA
Background
Adolescents with CKD often face significant mental health challenges that may affect their medication adherence. Despite the high prevalence of mental health concerns (specifically internalizing symptoms) in this population, the association between the severity of these symptoms and medication adherence remains underexplored.
Methods
The current cross-sectional study included adolescents with CKD who were prescribed an antihypertensive medication and completed the Behavior Assessment System for Children, 2nd edition Self-report (BASC-SRP-2). Antihypertensive medication adherence was objectively evaluated over 2 weeks using the MEMS cap. We used the BASC-SRP-2 depression, anxiety, somatization, and internalizing scales and classified participants into sub-clinical (T-score < 60) and at-risk (T-score ≥ 60) groups. We examined the associations between the selected BASC-SRP-2 domains and medication adherence using Wilcoxon rank-sum tests. Adjusted associations were evaluated with logistic regression models dichotomizing adherence as < 75% or ≥75% (covariates were age, race, sex, and income).
Results
The analyzed sample included 103 adolescents with CKD (M age = 15.4 years, SD = 2.44, 52% male, 44% White, 43% Black/African American, 14% Other; and (< $50,000: 38%, $50,000–$99,999: 27%, $100,000+: 35%) Table 1 provides information on the proportion of the sample at risk for elevated symptoms of the selected BASC-SRP domains. Medication adherence was significantly lower among adolescents with at-risk depression and internalizing problems compared to the sub-clinical group. Neither anxiety nor somatization were significantly associated with lower adherence. After adjusting for covariates, neither depression nor internalizing symptoms were significantly associated with adherence.
Conclusion
Adolescents with CKD may be at risk for high levels of mental health problems. When adolescents have At-risk levels of depression and internalizing problems, they may have significantly lower medication adherence compared to adolescents with subclinical symptoms. However, these associations were no longer significant after controlling for key demographic variables, which may be attributed to the smaller sample size. These results show the critical importance of addressing mental health problems in adolescents with CKD, which could improve adherence outcomes.