For patients with chronic illnesses, physical suffering is often inseparable from psychological suffering, and directly impacts mental health. It’s time we recognised patients as human beings in their entirety, writes Nicolás González Casares
Chronic illnesses profoundly impact patients' mental health, and understanding this relationship requires a holistic approach that transcends the traditional separation between body and mind. The dualism inherited from modern philosophical thought, which conceives of the mind and body as separate entities, has negatively influenced how we address diseases, leading to fragmented and often insufficient treatments. In the case of Chronic Kidney Disease (CKD), this need for an integrated perspective is particularly evident.
In chronic illnesses, physical suffering is inseparable from psychological suffering. The constant experience of pain, physical limitations, or recurring symptoms directly impacts mental health, often manifesting as anxiety, depression, or chronic stress. The dualistic perspective often treats these psychological effects as mere "consequences" of physical ailments, rather than recognizing them as interconnected elements of a single human reality. This reductionist approach hinders comprehensive treatment and, consequently, deprives the patient of a more effective recovery.
CKD represents a significant physical and emotional burden for patients. The need to undergo regular treatments such as dialysis, radical lifestyle changes, and the inevitable progression of the disease create constant stress. In this context, the psychological impact cannot be separated from the physical. Depression and anxiety are highly prevalent among individuals with CKD, not only due to physical suffering but also because of the uncertainty of the prognosis and the limitations the disease imposes on their daily lives.
A holistic approach not only improves medical outcomes but also restores to patients a sense of control and dignity in a process that might otherwise feel profoundly dehumanizing
One common yet often overlooked disruptive condition is CKD-associated pruritus (CKD-aP), defined by potentially extreme itching that leads those suffering from it to scratch uncontrollably and damage their own skin. Associated symptoms can affect patients’ ability to sleep, concentrate, and perform daily activities, significantly affecting their quality of life. Often feeling embarrassed by the wrongly perceived connection to their personal hygiene, many patients suffer in silence and underreport CKD-aP.
However, under a dualistic perspective, these psychological issues are often viewed as "side effects," ignoring how they directly affect the progression of the disease and the response to treatment. The holistic paradigm invites us to treat CKD not merely as a kidney disease but as a condition that transforms the patient's life in multiple dimensions. Medical care should integrate physical therapies with psychological strategies, addressing issues such as stress management, the building of social support networks, and emotional education. For instance, incorporating support groups or therapy programs can help patients cope with dialysis-related anxiety or fears about kidney transplantation. At the same time, practices such as mindfulness can enhance pain perception and overall well-being, reducing the emotional burden associated with the condition.
Moreover, the social and economic limitations accompanying CKD, and CKD-aP, such as job loss or financial dependence, underscore the need for an approach that encompasses mental health, quality of life, and patient resilience. This holistic approach not only benefits the individual but can also reduce overall healthcare costs by minimizing complications arising from stress and poor treatment adherence.
In conclusion, addressing CKD and other chronic illnesses from a holistic perspective allows us to break down the artificial barriers between body and mind. This not only improves medical outcomes but also restores to patients a sense of control and dignity in a process that might otherwise feel profoundly dehumanizing. Recognizing the human being in their entirety is ultimately the only way to provide truly effective and compassionate medical care.
Nicolás González Casares is an S&D MEP and member of the SANT Subcommittee
In today’s rapidly evolving healthcare landscape, addressing the full spectrum of patient needs is more important than ever. To achieve this, we must drive a more inclusive health strategy that not only addresses unmet patient needs but also fully integrates mental health, ensuring patients are meaningfully involved as key stakeholders in shaping future solutions, writes Sandra Ruckstuhl, Head of Corporate and External Affairs, CSL Vifor
Healthcare systems across Europe face significant challenges, including an aging population and increasing chronic disease prevalence. While advancements have been made in managing chronic conditions, integrating mental health issues into comprehensive patient care pathways remains a crucial gap that should not be minimised.
Chronic kidney disease-associated pruritus (CKD-aP) is a compelling example where the burden on patients goes far beyond physical symptoms, with mental health impacts frequently overlooked. CKD-aP is one of the most common yet often overlooked disruptive conditions of chronic kidney disease (CKD), characterized by potentially extreme itching that leads those affected to scratch uncontrollably, often causing skin damage and infections. CKD-aP illustrates how unaddressed mental health effects can intensify the overall burden of chronic conditions.
CKD-aP illustrates how unaddressed mental health effects can intensify the overall burden of chronic conditions
Across the EU, unmet medical needs in healthcare leave many patients without access to comprehensive care, especially in the realm of mental health. For those with chronic conditions, such as CKD-aP, these gaps are especially impactful, placing a heavy burden not only on patients but also on healthcare systems. The physical symptoms of CKD-aP are often exacerbated by mental health challenges, including sleep disturbances, anxiety, and depression, which significantly diminish quality of life [1]. This highlights the crucial role of mental health in boosting both individuals and population resilience.
Although existing recommendations address treatment for CKD-aP, further efforts are needed to update international guidelines to better incorporate the impact of the condition on patients’ mental health. The comprehensive mental healthcare strategy proposed by the European Commission in 2023[2] is the beginning of a new strategic approach to put mental health on par with physical health. By addressing both needs, this strategy sets the path to develop and implement a new EU health ambitious approach that puts people first.
Addressing the diverse and persistent mental health challenges linked to various diseases and conditions should be a top priority. By placing mental health at the core of care pathways, we can enhance patient outcomes, enabling individuals to thrive in their lives. EU institutions must seize the opportunity to integrate the full spectrum of mental health, ranging from prevention and mental health promotion to care and cure. This approach will fill existing gaps in care and foster a healthier, more resilient future for Europe. The time for action is now!
Sandra Ruckstuhl is Head of Corporate and External Affairs at CSL Vifor
[1] Shirazian, S., Aina, O., Park, Y., Chowdhury, N., Leger, K., Hou, L., Miyawaki, N., & Mathur, V. (2017). Chronic kidney diseaseassociated pruritus: impact on quality of life and current management challenges. International Journal of Nephrology and Renovascular Disease, 10, 11 - 26. https://doi.org/10.2147/IJNRD.S108045
[2]European Commission (2023). Communication from the Commission to the European Parliament, the Council, the European Economics and Social Committee and the Committee of the Regions on a comprehensive approach to mental health. (EC).
Disclaimer: MED-HQ-DFK-2400027