目的:据报道,晚期慢性肾脏病(CKD)患者经历了深刻的社会心理困扰。其他工作已经确定,来自边缘化人群的CKD患者(包括基于种族的个人经常面临种族主义和相关歧视,称为“种族化”)经历医疗保健不平等。鉴于这两种现象相交的信息有限,我们在患有晚期CKD的加拿大人中评估了心理社会困扰与种族身份和移民身份的关联.
方法:横截面数据的二次分析。
方法:来自多伦多多个临床中心的536例晚期CKD患者(估计肾小球滤过率<30mL/min/1.73m2,有或没有肾脏替代治疗)。
方法:种族身份(识别为亚洲人或非洲人的人,加勒比,或加拿大黑人),移民身份,以及移民种族化的综合身份。
结果:社会心理困扰,定义为抑郁症的存在,焦虑,或社会困难(即,患者健康问卷9、广泛性焦虑症7或社交困扰16量表得分≥10分,分别)。
方法:种族身份和移民身份与社会心理困扰的独立关联,抑郁症,焦虑,使用单变量和多变量调整逻辑回归检查社会困难。
结果:536名参与者的平均年龄为57±16(SD)岁,62%为男性,45%是移民。在样本中,58%是白人,22%是非洲人,加勒比,或者加拿大黑人,20%是亚洲人。36%的参与者存在社会心理困扰(19%的参与者患有抑郁症,焦虑占12%,和31%的社会困难)。为了评估种族化和移民身份的综合影响,我们创建了一个具有互斥类别的变量:白人非移民,种族化的非移民,白人移民,和种族化的移民参与者。在我们最终的多变量调整模型中,与白人非移民参与者相比,种族化的移民参与者更有可能患有心理社会困扰(或,2.96[95%CI,1.81-4.81]),抑郁症(或,1.87[95%CI,1.05-3.34]),和社会困难(或,3.36[95%CI,2.03-5.57])。种族化的非移民和白人移民总体上相似。
结论:方便样本;小亚组;联合暴露变量分组亚洲和非洲,加勒比,和黑人参与者在一起;缺乏有关机制的数据。
结论:基于人口统计学特征自我报告的种族化和移民身份与晚期CKD患者的社会心理困扰相关。这些患者可能受益于文化上有能力的社会心理支持。
UNASSIGNED:心理社会困扰在晚期慢性肾脏病患者中常见,影响生活质量和临床结局。在种族化(由于其在特定种族群体中的成员而被边缘化)和/或移民的人中,社会心理困扰可能尤其严重。我们评估了患有晚期慢性肾脏疾病的加拿大人的社会心理困扰与种族和移民身份的关系。来自多伦多多个医疗中心的536名参与者中,我们发现种族和移民参与者更有可能有心理社会困扰,抑郁症,与白人非移民参与者相比,社会困难。这可能与多重交叉挑战有关,包括种族化移民患者可能面临的种族主义和歧视的经验。需要进一步的研究来阐明导致更多痛苦的具体因素。文化能力和安全支持对这些患者的潜在影响也需要研究。
Patients with advanced chronic kidney disease (CKD) have been reported to experience profound psychosocial distress. Other work has established that patients with CKD from marginalized populations (including individuals who on the basis of race often face racism and related discrimination, termed \"racialization\") experience health care inequities. Given limited information on the intersection of these 2 phenomena, we assessed the association of psychosocial distress with racialized status and immigrant status in Canadians with advanced CKD.
Secondary analysis of cross-sectional data.
536 patients with advanced CKD (estimated glomerular filtration rate<30mL/min/1.73m2, with or without kidney replacement therapy) from multiple clinical centers in Toronto.
Racialized status (individuals who identify as Asian or as African, Caribbean, or Black Canadian), immigrant status, and combined immigrant-racialized status.
Psychosocial distress, defined as the presence of depression, anxiety, or social difficulties (ie, a score of≥10 points on the Patient Health Questionnaire 9, Generalized Anxiety Disorder 7, or Social Distress 16 scales, respectively).
The independent associations of racialized status and immigrant status with psychosocial distress, depression, anxiety, and social difficulties were examined using univariable- and multivariable-adjusted logistic regression.
Mean age of the 536 participants was 57±16 (SD) years, 62% were male, and 45% were immigrants. Of the sample, 58% were White, 22% were African, Caribbean, or Black Canadian, and 20% were Asian. Psychosocial distress was present in 36% of participants (depression in 19%, anxiety in 12%, and social difficulties in 31%). To assess the combined impact of racialized and immigrant status, we created a variable with mutually exclusive categories: White nonimmigrant, racialized nonimmigrant, White immigrant, and racialized immigrant participants. In our final multivariable-adjusted model, compared with White nonimmigrant participants, racialized immigrant participants were more likely to have psychosocial distress (OR, 2.96 [95% CI, 1.81-4.81]), depression (OR, 1.87 [95% CI, 1.05-3.34]), and social difficulties (OR, 3.36 [95% CI, 2.03-5.57]). Overall similar associations were seen for racialized nonimmigrants and for White immigrants.
Convenience sample; small subgroups; combined exposure variable grouping Asian and African, Caribbean, and Black participants together; lack of data about mechanisms.
Both racialized and immigrant status based on self-report of demographic characteristics were associated with psychosocial distress among patients with advanced CKD. These patients may benefit from culturally competent psychosocial support.
Psychosocial distress is frequent in patients with advanced chronic kidney disease and impacts quality of life and clinical outcomes. Psychosocial distress may be especially scarring in people who are racialized (marginalized on account of their membership in a particular racial group) and/or who are immigrants. We assessed the association of psychosocial distress with racialized and immigrant status in Canadians with advanced chronic kidney disease. Among 536 participants from multiple medical centers in Toronto, we found that racialized and immigrant participants were more likely to have psychosocial distress, depression, and social difficulties compared with White nonimmigrant participants. This is likely related to the multiple intersectional challenges, including experience with racism and discrimination that racialized immigrant patients may face. Further studies are needed to elucidate the specific factors that contribute to more distress. The potential impact of culturally competent and safe support for these patients will also need to be studied.