Chronic Kidney Disease, Anxiety and Depression among American Blacks; Does Ethnicity Matter?

Introduction: Chronic kidney disease (CKD) is known to be associated with deterioration of mental health. However, it is clear that this link is over and beyond the effects of socio-economic factors and other medical conditions. This study had two aims: 1) to compare the association between CKD and general anxiety disorder (GAD) among the two major ethnic groups of American Blacks (e.g. African Americans and Caribbean Blacks), and 2) to compare the association between CKD and major depressive episode (MDE) between African Americans and Caribbean Blacks. Methods: We analyzed data from African Americans and Caribbean Blacks who participated in the National Survey of American Life (NSAL). Self-reported physician diagnosis of CKD was the independent variable. Outcomes were 12- month GAD and MDE measured by the World Mental Health Composite International Diagnostic Interview (CIDI), a fully structured diagnostic interview. Ethnic-specific logistic regressions were used to determine the associations between CKD and 12- month GAD and MDE, after controlling for the effects of age, sex, educational level, and 13 other medical conditions. Results: Although CKD was positively associated with GAD and MDE in bivariate analysis, this association did not remain statistically significant in the multivariate analysis which controlled for socio-economic factors and other medical conditions. The study suggested that the main confounders for the association between CKD, GAD, and MDE vary based on ethnicity. For instance, the chronic medical condition that may play the role of confounder for the association between CKD and 12-month GAD among African Americans and Caribbean Blacks might be hypertension and heart disease, respectively. Conclusion: Possible confounders of the associations between CKD and GAD and MDE among American Blacks vary by ethnicity. Further research is needed to determine the links between different types of CKD and poor mental health among American Blacks. Consideration of ethnicity might be important in evaluation and treatment of mental health problems among Black patients with CKD.