Mental Health
Mixed methods assessment of mental health among adolescents at high risk for CKD of non-traditional origin in Central America Selene Vences Brown* Selene Vences Brown Damaris López-Pilarte Juan José Amador Velasquez Samantha Magaly Rosario Amador Sanchez Madeleine K Scammell Dan Brooks Jessica Leibler
Chronic kidney disease of non-traditional origin (CKDnt) is a leading cause of mortality in Central America. The disease is characterized by acute onset in early life and rapid progression, and the full etiology remains unknown. Although devastating to communities and families, research on the mental health burden of the CKDnt epidemic is scant. We assessed frequency of experiencing depressive symptoms within a prospective cohort study of adolescents in Nicaragua, a region highly affected by CKDnt (n=486), using the Patient Health Questionnaire (PHQ-2). We used open-ended questions to explore worry about CKDnt and its impact on life choices, including education and employment. Among participants, 14.8% (n=72) scored ≥3 on the PHQ-2, indicating high risk for depression. This finding is consistent with U.S. based estimates for Hispanic young adults. Most participants reported “always” worrying about kidney health of family and friends (n=298; 61.6%) while 28.9% (n=140) expressed concern that their daily activities harmed their kidneys. Nearly 20% (19.8%; n=96) indicated that the epidemic affected their employment decisions, while 9.6% (n=45) noted that the CKD epidemic disrupted their educational plans. Using a systematic inductive thematic qualitative analysis, we identified major themes around employment disruption, including: fear of developing CKDnt, inability to work due to disease, and avoiding jobs that may harm the kidneys. Minor themes included limiting physical exertion at jobs with heat exposure and concerns related to passing employer health screenings. Themes around educational decisions included concerns for career preparation, financial stability, and negative psychological and emotional impacts affecting their ability to concentrate on their studies. Our findings suggest that the CKDnt epidemic negatively affects life choices and opportunities for young people in affected regions, with implications for financial stability and mental health.