Anxiety and depression symptomatology in adolescents with kidney disorders during transition: “perception of illness” and the “patient paradox”

BACKGROUND: The transition from pediatric to adult care represents a critical phase for adolescents with chronic kidney disease (CKD), potentially affecting both clinical management and psychological well-being. This study aimed to evaluate anxiety and depressive symptoms in adolescents with CKD undergoing a structured transition program and to identify clinical and demographic predictors of psychological distress. Psychological outcomes were also compared with those of a healthy age- and sex-matched control group. METHODS: A cross-sectional monocentric study was conducted at the Pediatric Nephrology and Dialysis Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna-Policlinico di Sant'Orsola, Bologna, Italy. The study included 93 adolescents and young adults with kidney disorders (mean age 17.4 ± 1.4 years) enrolled in a structured transition program. Psychological assessment was performed using BDI-II and STAI-S and T. A healthy control group (n = 186) was selected using propensity score matching (1:2 ratio) based on age and sex. Statistical analyses included t-tests, ANOVA, and multivariate linear regression models. RESULTS: Most patients reported minimal depressive symptoms, whereas clinically significant anxiety was observed in approximately one-third of the cohort. Psychological distress was not associated with clinical indicators such as eGFR, disease duration, or clinical complexity. However, higher daily medication dosing frequency and female sex emerged as significant predictors of increased anxiety and depressive symptoms. Unexpectedly, healthy controls reported higher levels of depression and trait anxiety than patients. CONCLUSIONS: Medication burden and sex, rather than eGFR, emerged as the primary predictors of psychological distress. Interestingly, patients exhibited lower anxiety and depression levels than their healthy peers, suggesting that intensive family and clinical care support, such as a structured clinical transition program, may act as a protective buffer.