Mental Health in Men with Chronic Kidney Disease

Chronic kidney disease has been recognised as a leading public health problem. More than 850 million people worldwide have some form of kidney disease. This is roughly double the number of people who live with diabetes (422 million) and 20 times the prevalence of cancer worldwide (42 million) . Chronic kidney disease (CKD) is characterised by a progressive and irreversible loss of kidney function. It is often referred to as a ‘silent illness’, with few signs or symptoms in the early stages, resulting in many patients only being diagnosed when their kidneys have almost failed.

Our mental health plays a central role in how we experience and how we cope with a chronic illness. Research has widely shown that loss of health is a major contributing factor in developing mental health problems. Neuropsychiatric conditions including depression, anxiety disorders and cognitive impairment have all been shown to be prevalent in patients with chronic kidney disease . These conditions are independently associated with poor clinical outcomes, including decrease in health-related quality of life, longer hospitalisation and higher risk of mortality . The prevalence of depression in CKD patients is three to four times higher when compared with the general public and two to three times higher when compared to other chronic diseases including diabetes, coronary artery disease and chronic obstructive pulmonary disease . Women, when suffering with a chronic illness, are more likely to ask for help than men with the same illness and are also more likely to ask for that help sooner. When it comes to kidney disease specifically, studies show that both male and female can suffer from depression and anxiety. Some more recent smaller studies show that women with CKD are more likely to suffer from anxiety, while men with CKD are more likely to suffer from depression .

Depression changes how we think, feel and function. Of course it is normal, when living with a chronic illness, for anyone to feel down. Dips in mood are an ordinary reaction to losses, setbacks, and disappointments. Depression interferes with how we care for ourselves, impacts relationships, sleep, diet and overall enjoyment of life. Depression can manifest in both physical and mental symptoms. There are various types of depression with respect to symptoms but there are some typical signs of depression: Feelings of hopelessness and helplessness; Low energy; Loss of interest in friends, activities, and things you used to enjoy; Feeling more irritable, short-tempered or aggressive than usual; Consuming more alcohol, engaging in reckless behaviour, or self-medicating; Feelings of restlessness and/or agitation; Sleep patterns, weight or appetite changes; Difficulty concentrating or finding it hard to make decisions; Difficulty controlling negative thoughts.

Unfortunately, depression in men can often get overlooked, as it can be masked by increased anger, violence or alcohol/ substance use. Many men find it difficult to talk about their feelings, they don’t want to be seen as weak or tearful as this is perceived to be incompatible with the typical societal male role. Men tend to focus more on the physical symptoms that often accompany male depression, such as back pain, headaches, difficulty sleeping, or sexual problems. These can all result in the underlying depression going untreated. In kidney patients, depression can be even more difficult to identify because key symptoms of depression like low energy, loss of weight or appetite and sleeping difficulties can be attributed to kidney disease itself.

CKD patients with depression have reported some of the following typical feelings and experiences:

• Regular pain and difficulty sleeping

• Feeling that their life is in the hands of those who care for them and their disease

• Unwanted feelings of dependence on health care providers and the dialysis machine

• Feelings of powerlessness over the disease

• Feelings of lack of control over their schedule and lives

• Inability to stand up to social pressures at the expense of their own health care needs, such as not following a renal food and fluid plan when out with friends

• Feelings of hopelessness that there are only treatment options rather than a cure for kidney disease

For men living with chronic kidney disease the risk of depression significantly increases and it can be intense and unrelenting. Despite its high prevalence and the significant clinical burden there is research to show that depression in CKD patients is underrecognised and an undertreated problem. Screening patients who show signs of depression or screening all CKD patients periodically, using screening tools like the patient health questionnaire (PHQ-9) or Beck’s Depression Inventory assessment (BDI), might help to identify patients who need support.

The Irish Kidney Association provides a free counselling service to all those affected by and living with end stage chronic kidney disease, their families and carers. Please email counselling@ika.ie for further information.

Written by Aoife Smith, Psychotherapist MIACP, Coordinator of Counselling Services, Irish Kidney Association

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