When new patients begin working with Interwell Health, one of the first series of questions asked by the care team seeks to determine if they are experiencing depression, anxiety, or are at-risk. Those questions, from the patient health questionnaires 4 and 9 (PHQ), have been highly effective in screening patients and identifying concerns early.
“Every patient is screened for depression by our nurses at the beginning of our relationship, and this is repeated at least annually if not more frequently,” says Kasey Bosco, a social worker and nursing supervisor overseeing Interwell’s care program for patients with late-stage chronic kidney disease (CKD).
Studies have shown a high prevalence of depression in patients with both late-stage CKD and end-stage kidney disease (ESKD), and patients on dialysis are even more likely to experience symptoms.
A review of 216 studies published in the journal Kidney International Reports, found that 27% of CKD patients screened were considered depressed, compared to 39% for people with ESKD. This is up to four times higher than the general population, and higher than those individuals with other chronic conditions. Minority racial and ethnic groups, including Black and Hispanic patients, have demonstrated even higher rates of depression.
Early identification of depression in patients with CKD ensures they receive the proper help and support. This is especially important given the strong association of depression with worse health outcomes and a poor quality of life.
“We provide counseling and referrals to outpatient behavioral health when needed and we also connect patients to community resources,” explained Bosco. “Our social workers spend a lot of time listening, so they can better understand what our patients are going through.”
New Advisory on Loneliness Notes Adverse Health Outcomes
In May 2023, U.S. Surgeon General Dr. Vivek Murthy released an advisory calling attention to the public health crisis of loneliness, isolation, and lack of connection being experienced by too many Americans.
The advisory noted that half of U.S. adults reported experiencing measurable levels of loneliness and said physical health consequences of poor or insufficient connection include a 29% increased risk of heart disease, a leading indicator of kidney disease. A lack of social connection increases risk of premature death by more than 60%.
“Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders,” said Dr. Murthy.
Government Value-Based Models Require Screening
Addressing depression is a critical component of the government’s Comprehensive Kidney Care Contracting (CKCC) program, of which Interwell is the largest participant with more than 60,000 patients enrolled nationwide. This program specifically measures depression remission as a key metric of success.
In 2022, Interwell Health screened tens of thousands of patients for depression across all its programs. It’s been a valuable tool to help drive improvements in patients’ health and well-being.
“People living with kidney disease are able to live a healthier life when empowered and motivated to improve their mental health,” said Jessica Demaline, social worker and senior vice president for healthcare operations at Interwell Health. “Coping with a chronic illness, such as chronic kidney disease, is challenging. The challenge is amplified when a patient is also experiencing depression and anxiety. That’s why addressing depression, anxiety, and loneliness is so important to improving health outcomes.”
Bosco says it’s important to help patients take concrete steps that can reduce the risk of depression. She believes value-based care provides resources that are often hard to find, coordinate, or pay for in a fee-for-service environment.
“Our clinicians really focus on wellness whether it’s exercise, reconnecting with family, working on mindfulness, or simply getting outside,” said Bosco. “Our social workers have a lot of tools and strategies to decrease isolation. It may be sitting on your front porch. It could be getting connected to a senior center to socialize more. We encourage them to take even the smallest steps to reduce that isolation.”