630 - Understanding the Association Between Mental Health and Medication Adherence in Adolescents with Chronic Kidney Disease

Publication Number: 630.6742

Christabelle E. Ayensu-Asiedu, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States; Cozumel Pruette, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Tammy M. Brady, Johns Hopkins University, Baltimore, MD, United States; Michelle Eakin, Johns Hopkins University, Baltimore, MD, United States; Kristin A. Riekert, Johns Hopkins University School of Medicine, Ellicott City, MD, United States; Cyd Eaton, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Background: Adolescents with CKD often face significant mental health challenges that may affect their medication adherence. Despite the high prevalence of mental health concerns (specifically internalizing symptoms) in this population, the association between the severity of these symptoms and medication adherence remains underexplored.

Objective: To evaluate associations between mental health symptoms and electronically-monitored medication adherence in adolescents with chronic kidney disease (CKD).

Design/Methods: The current cross-sectional study included adolescents with CKD who were prescribed an antihypertensive medication and completed the Behavior Assessment System for Children, 2nd edition Self-report (BASC-SRP-2). Antihypertensive medication adherence was objectively evaluated over 2 weeks using the MEMS cap. We used the BASC-SRP-2 depression, anxiety, somatization, and internalizing scales and classified participants into sub-clinical (T-score < 60) and at-risk (T-score ≥ 60) groups. We examined the associations between the selected BASC-SRP-2 domains and medication adherence using Wilcoxon rank-sum tests. Adjusted associations were evaluated with logistic regression models dichotomizing adherence as < 75% or ≥75% (covariates were age, race, sex, and income).

Results: The analyzed sample included 103 adolescents with CKD (M age=15.4 years, SD=2.44, 52% male, 44% White, 43% Black/African American, 14% Other; and ( < $50,000: 38%, $50,000–$99,999: 27%, $100,000+: 35%) Table 1 provides information on the proportion of the sample at risk for elevated symptoms of the selected BASC-SRP-2 domains. Medication adherence was significantly lower among adolescents with at-risk depression and internalizing problems compared to the sub-clinical groups. Neither anxiety nor somatization symptoms were significantly associated with lower adherence. After adjusting for demographic covariates, neither depression nor internalizing symptoms were significantly associated with adherence.

Conclusion(s): Adolescents with CKD may be at a higher risk for mental health problems compared to the general population. When adolescents report elevated depressive and internalizing symptoms, they may have significantly lower medication adherence compared to adolescents with subclinical symptoms. While these associations were no longer significant after controlling for key demographics, our results highlight the critical importance of addressing mental health problems in adolescents with CKD and suggest this could improve medication adherence.