Abstract
Objectives: To determine the feasibility and utility of screening renal pre-dialysis and pre-transplant patients for psychiatric disorder and functional impairment.
Methods: Educational programs with accompanying educational literature were offered to all patients about to enter dialysis programs, and to all eligible for kidney or combined kidney and pancreas transplant. All patients were then sent the SF36, Patient Health Questionnaire (a self-report version of the PRIME-MD), and the Well-Being Questionnaire, together with utility questionnaires. They were offered an interview with a member of the Renal Consultation-Liaison Psychiatry team. This interview was compulsory for all potential living kidney and kidney/pancreas recipients. At interview, the IQCODE questionnaire was completed by the person who attended with the patient, and the MMSE performed. The BDI and STAI were administered where the PHQ and clinical interview indicated a diagnosis of depression or anxiety. Treatment plans were instituted where appropriate. Patients were followed up by repeat questionnaires at 6 months, and interviews where issues of concern were identified.
Results: There was an 80% compliance for pre-dialysis patients and 100% compliance for transplant patients. The questionnaires items were considered “some” to “mostly” relevant. SF-36 data for the 4 month outcome of 11 living kidney recipients show that Physical Component Score (PCS) rose from 42.9%±10.9SD to 50.2% ± 7.8, and the Mental Component Score (MCS) from 41.4% ± 13.9 to 52.3% ± 7.4. Thus the physical functioning was equal to the standardised Australian mean (50%) and the mental functioning higher than the Australian mean (50%) after the operation. This is consistent with the responses to the PHQ and to clinical assessment. Individual responses to questionnaires were found to be useful in drawing renal physician's attention to possible mental health problems.
Conclusions: The educational and screening program was found to be feasible and acceptable to patients in general. It normalised the psychosocial issues and provided a structured basis for the review of each patient. Further analysis will help refine the process and define which patients need to be interviewed.