#4016 MENTAL HEALTH OF PEOPLE WITH KIDNEY DISEASE AND THEIR SIGNIFICANT OTHERS BEFORE AND AFTER THE COVID-19 VACCINE PROGRAMME
Authors: Patel Naeema A , Sohansoha Gurneet K , Ford Ella , Wilkinson Thomas , Lightfoot Courtney J , Smith Alice 
Published: June 2023

Abstract

Background and Aims
The COVID-19 pandemic resulted in widespread psychological distress, including depression, anxiety, and stress, especially in clinically vulnerable people such as those with chronic kidney disease (CKD). In the UK, high rates of infection, severe illness and death, and profound changes to usual activities and healthcare delivery imposed by social distancing and isolation persisted throughout 2020 and only began to abate after the introduction of the COVID-19 vaccination programme early in 2021. We conducted a survey to assess levels of general depression, anxiety, stress and health anxiety in people with non-dialysis CKD (ND-CKD), kidney transplant recipients (KTRs), and their significant others (SOs) at two timepoints: during the Autumn of 2020 when COVID-19 levels and social restrictions were high, and in May 2021 after the majority of the population had been vaccinated. We hypothesised that the mental health status of people affected by CKD would improve after receiving the vaccine.

Method
11 hospital sites in England invited local patients and their SOs to complete an online survey in Autumn 2020, and a follow-up in May 2021. The survey included two validated mental health questionnaires: the Depression, Anxiety and Stress Scale (DASS-21) and the Short Health Anxiety Index (SHAI). Higher scores are indicative of higher levels of depression, stress and anxiety, and health anxiety respectively. One-way ANOVA was used to compare questionnaire scores between the three participant groups, and paired sample t-tests were used to assess changes between the two timepoints for each group.

Results
381 participants completed the Autumn 2020 survey: 123 ND-CKD (61% male, mean age 64[SD:14] years), 150 KTRs (51% male, 59[SD:12] years), and 108 SOs (39% male, 60[SD:13] years). 318 completed the May 2021 follow-up survey. 174 participants completed both surveys. In Autumn 2020, people with ND-CKD had significantly higher DASS-21 anxiety scores than SOs (p = 0.029). Both ND-CKD and KTRs had significantly higher health anxiety scores than SOs at baseline (P&lt;0.001), and at follow-up (ND-CKD, P = 0.006; KTR, P = 0.010). In May 2021, 95% of participants had received the COVID-19 vaccine. There were no significant changes in DASS-21 subscale scores or SHAI scores between the Autumn 2020 and May 2021 timepoints for any of the participant groups.

Conclusion
Our results show that during the COVID-19 pandemic, people living with ND-CKD and KTRs had higher levels of health-related anxiety than their SOs. As the COVID-19 vaccine programme reduced health risks and allowed relaxation of social restrictions, it may be expected to result in improved population mental health. However, in May 2021, we found no improvement in depression, anxiety, stress, or health anxiety among people living with CKD or their SOs despite nearly all the participants having received the vaccine. It is likely that increased social mixing and marked reduction in public mask-wearing led to persistently high anxiety levels in clinically vulnerable people and those who live with them. Today, the majority of the public have returned to “normal” social behaviour and masks are rarely worn, but COVID-19 remains a threat to people with CKD. There is an urgent need for better mental health support among the kidney community.