Psychosocial distress (depression, anxiety and social difficulties) is frequent in end stage kidney disease (ESKD) patients. Immigrants face challenges during the process of integration potentially resulting in increased psychosocial distress.
To assess the associations between immigrant status and psychosocial distress in Canadians with ESKD.
Cross-sectional, convenience sample of predialysis, dialysis and post-transplant patients with ESKD in Toronto. We used the Distress Assessment and Response Tool to assess distress. This includes the PHQ-9 questionnaire for depression, GAD-7 for anxiety and the Social Difficulties Inventory (SDI) for social difficulties. Anxiety, depression, and social difficulties were defined as a score of ?10 on the GAD-7, PHQ-9, and SDI, respectively; ?any distress? as ?10 on any of the scales. Ethnocultural and demographic information was collected using a tablet-based electronic data capture system. Chi-square tests and logistic regression models were used to assess the association between distress and immigrant status.
Among the 431 participants (mean [SD] age 56  years, 59% male, 49% immigrants), 77% of non-immigrants were Caucasian, compared to 29% of immigrants. Depression was present in 20%, anxiety in 13%, social difficulties in 32% and any distress in 38% of the participants. Social difficulties (38 vs 27%, p=0.019) and ?any distress? (42 vs 31%, p=0.011) were higher among immigrants compared to nonimmigrants. The association for ?social difficulties? (OR=1.78; 95%CI=1.02-3.12, p= 0.043) and ?any distress? (OR=1.83; 95%CI=1.11-3.05, p= 0.019) was significant, even after adjusting for potential covariables. The association for ?social difficulties? (OR=1.15; 95%CI=0.62-2.14, p= 0.639) and ?any distress? (OR=1.45; 95%CI=0.84-2.53, p= 0.178) became insignificant after adjusting for ethnicity. To assess the combined impact of ethnicity and immigrant status, mutually exclusive variables: white-nonimmigrants, white-immigrants, nonimmigrant others and immigrant others were created. In the fully adjusted models compared to white-nonimmigrants, immigrant others (OR=2.94; 95%CI=1.64-5.28, p<0.05) had higher odds for any distress. The association for nonimmigrant other (OR=1.95; 95%CI=0.74-5.12, p= 0.167) and immigrant white participants (OR=1.85; 95%CI=0.89-3.88, p= 0.097) was not statistically significant.
Psychosocial distress is associated with both immigrant status and ethnicity in patients with ESKD. These patients may benefit from additional psychosocial support.