Employment Status and Associations with Workability, Quality of Life and Mental Health after Kidney Transplantation in Austria.

Galateja Jordakieva,Margarete Steiner,Wolfgang Winnicki,Alexander R Rosenkranz,Gere Sunder-Plaßmann,Moritz Brooks,Igor Grabovac,Sabine Zitta,Jasminka Godnic-Cvar,Sinisa Stefanac

doi:10.3390/ijerph17041254

Abstract

Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 ± 9.07 years; 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (<0.001). Unemployed KTRs reported fatigue and mental health issues more often (p < 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS; odds ratio (OR) = 3.39; 95% confidence interval (CI) = 1.97–5.82; p < 0.001), partnership (OR = 5.47; 95% CI 1.43–20.91; p = 0.013) and no psychological counseling after KTx (OR = 0.06; 95% CI = 0.003–0.969; p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.

Highlights

Each year, approximately 600–800 patients with end-stage renal disease (ESRD) throughoutAustria are listed for kidney transplantation (KTx)
The study sample was stratified by employment status, with 51.8% of participants reporting being employed
Significant differences were observed regarding education level, i.e., a higher education level was found among employed subjects compared to unemployed subjects, and partnership status, i.e., employed subjects reported living in partnership more often than unemployed

Summary

Introduction

Austria are listed for kidney transplantation (KTx). In kidney transplant recipients (KTRs), vocational rehabilitation is desirable, as reports over the past decade indicate that the overwhelming majority (60–70%) of transplant recipients in Austria are of working age [2]. Returning to normality and “full-life” participation, e.g., working and community life, are an essential need of most KTRs [3]. As employment is known to have several salutogenetic effects, return to work (RTW) is associated with higher quality of life (QoL) as well as better emotional and mental health in these patients [4,5,6,7]. Employment post-KTx was associated with overall KTR and allograft survival [8]

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