O7
Integrating Mental and Physical Healthcare in Kidney Patients: A Comparison of
Psychological Morbidity in Three Patient Groups.
Carroll, A1., Frame, S1., Kerr, C1., Beleno-Harriott, A1., Desendario, E1.,
Taylor, J2., Matcham, F2., Simpson, A.,2 Hotopf, M2., & Cronin .A. J.1,2
1
Guy’s & St Thomas’ NHS Foundation Trust
2
Kings College London
Background: There is an increased prevalence of depression and anxiety in kidney transplant
and dialysis patients, and this is associated with increased mortality and co-morbidity.
Integrating physical and mental health care is a key national priority in the UK. IMPARTS
(Integrating Mental and Physical Health Care in Research Training and Services) is a
screening package that has been developed to facilitate this through the electronic collection
of patient reported data. To investigate the prevalence of psychological morbidity in kidney
patients we incorporated IMPARTS into three clinical areas: (i) The Annual Transplant
Review Clinic (ATRC), for long-term kidney transplant patients (>8 years); (ii) The
Transplant Support Clinic (TSC), for kidney transplant patients with declining graft function
(GFR<20mL/min); and (iii) A satellite dialysis centre.
Methods: Between July 2013 and January 2015 we screened n=577 patients using an
electronic tablet either prior to clinical consultation or while they were receiving dialysis.
Screening measures for depression and anxiety included: (i) Patient Health Questionnaire
(PHQ-9); and (ii) Generalised Anxiety Disorder Questionnaire (GAD-7). The results were
uploaded in ‘real-time’ to the Electronic Patient Record.
Results: There were a total of n=577 screening encounters (ATRC n=380, TSC n=35,
Dialysis n=162). The mean age of patients screened was 50.4 years (ATRC 53.4 years, TSC
43.6 years, Dialysis 54.2 years). On average 39% screened were female (ATRC 38%, TSC
48%, Dialysis 41%). The prevalence of depression and anxiety across each clinical group is
shown in table one.
Table One: Prevalence of Depression and Anxiety across ATRC, TSC and Dialysis
ATRC (%)
TSC (%)
Dialysis (%)
290 (90.9)
22 (62.9)
82 (70.1)
Depression: No symptoms
Some Symptoms
17 (5.3)
6 (17.1)
23 (19.7)
Probable Major depression
12 (3.8)
7 (20)
12 (10.3)
No symptoms
287 (90)
27 (77.1)
92 (78.6)
Anxiety:
Mild anxiety
14 (4.4)
3 (8.6)
10 (8.5)
Probable GAD
18 (5.6)
5 (14.3)
15 (12.8)
All patients who reported psychological difficulties were offered follow up with a clinical
psychologist. Referrals were also made to liaison psychiatry and community mental health
teams.
Discussion: We have successfully embedded IMPARTS into three distinct clinical areas and
identified significant psychological morbidity across all kidney patient groups screened. This
has resulted in patients being offered increased psychological support and prompted a more
holistic approach to patient care. It has also identified important areas for further evaluation
and service development. For example providing psychological support for patients attending
TSC, who have a particularly high prevalence of probable major depression and GAD, has
been identified as a priority. Further analyses to identify associations between physical (e.g.
Glomerular filtration rate and Haemoglobin) and mental health parameters are underway, the
results of which we anticipate will, in time, inform targeted treatment and management to
improve clinical outcomes.