Baseline psychiatric assessment in Chronic Kidney Disease in Children study may be limited
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Researchers used baseline data from the Chronic Kidney Disease in Children cohort study to compare psychiatric disorders in children with CKD and children in the general population and yielded results inconsistent with previous studies.
While the analysis indicated children with CKD were more likely to have depression and were less likely to have anxiety compared with children in the general population, researchers suggested that the baseline assessments in the Chronic Kidney Disease in Children cohort study (CKiD) may not be acceptable for describing psychiatric disorders among children with CKD.
“Limited data suggest a prevalence of 60 [to] 70% of any psychiatric diagnosis among children with CKD and up to 50% of those with a psychiatric diagnosis have multiple diagnoses,” Jessica L. Stahl, MD, MS, from the University of North Carolina Kidney Center, and colleagues wrote. They added, “To address this knowledge gap, we used data from the CKiD and the National Survey of Children’s Health (NSCH) to examine the relative prevalence of common psychiatric disorders between children with CKD and in the general pediatric population.”
The cross-sectional analysis included 875 children aged 2 to 17 years with CKD and a general population of 72,999 children. All participants saw a medical provider within 12 months of enrollment.
Children in the CKiD study completed a two-part baseline assessment at study enrollment and those in NSCH reported data during phone interviews.
To determine parent-reported diagnoses of depression, anxiety or ADHD, researchers compared data from the CKiD study and the NSCH. Then, researchers identified the age, sex and race-adjusted prevalence ratio (aPR) by comparing diagnoses of children with CKD to the general population using Poisson regression.
Additionally, researchers explored the associated between “depression status using standardized self-reported screening instrument scores and parent-reported diagnosis.”
Analyses revealed children with CKD had aPR of 1.32 for depression, 0.72 for anxiety and 1.03 for ADHD. Additionally, children with CKD were 32% more likely to be diagnosed with CKD, 3% more likely to be diagnosed with ADHD and 28% less likely to be diagnosed with anxiety compared with children of the general population. Researchers determined the association of parent-reported diagnosis and instrument-detected depression was weak (r=0.13).
“Despite highly comparable CKiD and NSCH data, the inconsistencies between our results and previous studies suggest that isolated use of the baseline parent-report assessments from the CKiD database may have limited utility in evaluating a history of psychiatric disorders among children with CKD,” Stahl and colleagues wrote. “Improved diagnostic classification is a critical first step to better understanding the relationship between CKD and mental illness to guide our development of targeted interventions to address and prevent the development of psychiatric disorders in this population.”
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