Health Care Utilization Among Adults With CKD and Psychological uistress

Rationale & Objective: Despite extensive research on health care access for individuals with chronic kidney disease (CKD), there is little research on the relationship between health care access barriers and psychological distress. Study design: An observational study based on the publicly available 2013 to 2017 US National Health Interview Survey data. Setting & Participants: 3,923 respondents 18 years or older who self-reported a diagnosis of CKD in the preceding 12 months. Predictor(s) & Outcome(s): Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Barriers to health care access included lack of health insurance coverage, lack of a usual source of health care, and financial barriers to accessing/obtaining health care, including medical specialist services, prescription drugs, mental health counseling, and dental care. Analytical Approach: Multinomial logistic regression with 3 levels of K6 scores (no distress, mild to moderate distress, and serious distress) as the dependent variable. Results: 15% of respondents reported mild to moderate and 11 % reported serious psychological distress. Compared with those with no distress, those with mild to moderate and serious distress were younger but less likely to have worked in the preceding year, had more chronic medical conditions, and visited an emergency department more frequently. Multivariable regression models show that each financial barrier to health care access (likely due to lack of health insurance) was significantly associated with mild to moderate and serious distress. Limitations: CKD diagnosis was self-reported and CKD stage was unknown. Because this is a crosssectional study, associations cannot be assumed to imply causal relationships. Conclusions: Access to sick and preventive/ routine care should be improved. People with CKD should be assessed for psychological distress, treated as needed, and offered case management and social services to help them navigate the health care system and alleviate personal stressors.