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Pearce CJ, Hall N, Hudson JL, Farrington K, Tucker MJR, Wellsted D, Jones J, Sharma S, Norton S, Ormandy P, Palmer N, Quinnell A, Fitzgerald L, Griffiths S, Chilcot J. Approaches to the identification and management of depression in people living with chronic kidney disease: A scoping review of 860 papers. J Ren Care 2024; 50:4-14. [PMID: 36645375 DOI: 10.1111/jorc.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease. OBJECTIVES To investigate how depression is identified and managed in adults with Chronic Kidney Disease. DESIGN Scoping review. METHODS Systematic search of eight databases with pre-defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted. RESULTS Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies. CONCLUSIONS Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better-quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression.
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Affiliation(s)
- Christina J Pearce
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Joanna L Hudson
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
- Renal Unit, Lister Hospital, Stevenage, UK
| | | | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Nick Palmer
- Independent PPI lead & Kidney Care UK, Alton, UK
| | | | - Lauren Fitzgerald
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sophie Griffiths
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joseph Chilcot
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Fadipe MF, Aggarwal S, Johnson C, Beauchamp JES. Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review. J Psychiatr Ment Health Nurs 2023; 30:885-898. [PMID: 37010913 DOI: 10.1111/jpm.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 04/04/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Depression is a leading cause of disability worldwide that negatively impacts quality of life. Talk therapy such as cognitive behavioural therapy is an effective treatment for depression. The Internet is an important tool for mental healthcare delivery. Internet-delivered or online talk therapy interventions are associated with lower costs and improved accessibility. Current reviews do not address the effectiveness of Internet-delivered cognitive behavioural therapy (iCBT) on quality of life (QoL). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Interventions for iCBT have better QoL improvements for individuals with greater depressive symptom severity, females, young adults and individuals with complex comorbid disorders. Support from a healthcare provider for iCBT interventions have better outcomes than self-guided therapy interventions. Tailoring the iCBT intervention to the specialized needs of the population is beneficial. WHAT ARE THE IMPLICATIONS FOR PRACTICE There is potential to address treatment gaps for managing the care of individuals with depression. Utilizing iCBT promotes the integration of accessible mental healthcare in clinical settings. Healthcare providers can have a more comprehensive approach to delivering iCBT by considering adaptations relevant to the clinical population being treated. ABSTRACT INTRODUCTION: Major depressive disorder (MDD) is a leading cause of disability resulting from social, psychological and biological factors affecting quality of life (QoL). Cognitive behavioural therapy (CBT) is an effective psychotherapy for MDD. Internet-delivered CBT (iCBT) is associated with lower costs and improved accessibility. AIM We aimed to examine the effectiveness of iCBT on QoL in adults with depression. METHOD PubMed, Embase and PsycINFO were searched between 2010 and 2022. Inclusion criteria were experimental designs, adults ≥18 years old, depression diagnosis or valid self-report measure, iCBT intervention; and QoL outcome. Exclusion criteria were studies without depression analysis and intellectual disabilities or psychosis. RESULTS Seventeen articles were included, with a negative correlation between depression severity and QoL. Sex, age and physical comorbidity positively influenced effectiveness. Depressive severity, dysfunctional attitude and negative thinking were predictors and moderators of QoL. Clinician support can impact social interactions and sense of belonging. DISCUSSION Internet-delivered cognitive behavioural therapy is effective for improving QoL in adults with MDD. Severe depression, females, younger age and comorbid disorders were associated with greater QoL improvements. IMPLICATIONS FOR PRACTICE The findings suggest iCBT could address depression treatment gaps related to improving QoL. Utilizing iCBT potentially improves the care continuum for individuals with complex disorders.
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Affiliation(s)
- Melissa F Fadipe
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Seema Aggarwal
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Constance Johnson
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jennifer E S Beauchamp
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
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González-Flores CJ, Garcia-Garcia G, Lerma C, Guzmán-Saldaña RME, Lerma A. Effect of Cognitive Behavioral Intervention Combined with the Resilience Model to Decrease Depression and Anxiety Symptoms and Increase the Quality of Life in ESRD Patients Treated with Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5981. [PMID: 37297585 PMCID: PMC10252699 DOI: 10.3390/ijerph20115981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
The aim of this study was to compare the effect of cognitive behavioral intervention (CBI) combined with the resilience model (CBI + R) vs CBI alone on depression symptoms, anxiety symptoms, and quality of life of end-stage renal disease (ESRD) patients undergoing hemodialysis replacement therapy. METHOD Fifty-three subjects were randomly assigned to one of two treatment groups. The control group (n = 25) was provided with treatment strategies based on a cognitive behavioral approach, while the experimental group (n = 28) were given the same techniques plus resilience model strategies. Five psychological instruments were applied: Beck Depression Inventory, Beck Anxiety Inventory, Mexican Resilience Scale, cognitive distortions scale, and the Kidney Disease related Quality of Life questionnaire. Participants were assessed at baseline (before treatment), eight weeks later (end of treatment), and four weeks after the end of treatment (follow up). The results were analyzed by ANOVA for repeated measures with a Bonferroni-adjusted test method, with p < 0.05 considered significant. RESULTS The experimental group had significant differences in total and somatic depression as well as differences in the dimensions of cognitive distortions and a significant increase in the dimensions of resilience. The control group had significant differences in all variables but showed lower scores in the evaluated times. CONCLUSIONS The resilience model strengthens and enhances the effectiveness of the cognitive behavioral approach to reduce symptoms of depression and anxiety in patients with ESRD.
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Affiliation(s)
| | - Guillermo Garcia-Garcia
- Nephrology Department, Civil Hospital de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico;
| | - Claudia Lerma
- Instituto Nacional de Cardiología Ignacio Chávez, México City 14080, Mexico;
| | | | - Abel Lerma
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico;
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Barello S, Anderson G, Acampora M, Bosio C, Guida E, Irace V, Guastoni CM, Bertani B, Graffigna G. The effect of psychosocial interventions on depression, anxiety, and quality of life in hemodialysis patients: a systematic review and a meta-analysis. Int Urol Nephrol 2023; 55:897-912. [PMID: 36180655 PMCID: PMC10030538 DOI: 10.1007/s11255-022-03374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Hemodialysis has become a standard therapy for adults with end-stage renal diseases. Adults undergoing hemodialysis have to cope with unique psychological issues that make their care journey particularly fatiguing. In this systematic review and meta-analysis, we aimed to summarize and evaluate the effects of psychosocial interventions on the reduction of anxiety and depression in adults with HDs. METHODS We included randomized controlled trials and quasi-experimental studies that measure change in depression, anxiety, and quality of life. RESULTS We identify three categories of psychosocial interventions delivered to adults undergoing hemodialysis. Based on our analysis, there was a medium effect of psychosocial intervention on depression (SMD - 0.85, 95%CI - 1.17; - 0.52, I2 = 80%, p < 0.01) and anxiety (SMD - 0.99, 95%CI - 1.65; - 0.33, I2 = 88%, p < 0.01) in adults undergoing hemodialysis. CONCLUSIONS Psychosocial interventions, such as psychological support or relaxation-based therapy, seems all to reduce depression and anxiety in adults undergoing HD. Preliminary evidence suggests that there may be a benefit of psychosocial interventions on the quality of life for adults undergoing HD.
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Affiliation(s)
- Serena Barello
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy.
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy.
| | - Gloria Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Acampora
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Caterina Bosio
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Elena Guida
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vincenzo Irace
- Associazione Nazionale Emodializzati Emodialisi e Trapianto-ONLUS, Rome, Italy
| | | | - Barbara Bertani
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Ordine degli Psicologi della Lombardia, Milan, Italy
| | - Guendalina Graffigna
- EngageMinds HUB-Consumer, Food and Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, 26100, Cremona, Italy
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Marin AE, Redolat R, Gil-Gómez JA, Mesa-Gresa P. Addressing Cognitive Function and Psychological Well-Being in Chronic Kidney Disease: A Systematic Review on the Use of Technology-Based Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3342. [PMID: 36834042 PMCID: PMC9961918 DOI: 10.3390/ijerph20043342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
Patients with chronic kidney disease (CKD) are at risk of both a gradual decline in cognitive function and an increase in psychological distress. This includes symptoms of anxiety, depression, and sleep disturbances, all of which are factors that have been associated with increased morbidity and mortality. In response, we are now seeing that interventions based on new digital technologies are increasingly used in order to optimize patients' quality of life. Systematic research of the literature on electronic databases (MEDLINE/PubMed, Scopus, Web of Science, and PsycInfo/ProQuest) covering the period from 2012 to 2022 was conducted in order to methodically review the existing evidence regarding the implementation and effectiveness of technology-based interventions in the management of cognitive and psychological well-being symptoms in patients with CKD. A total of 739 articles were retrieved, 13 of which are included in the present review. All the studies focused on the usability, acceptability, and feasibility of technology-based interventions aimed at psychological symptoms, with no studies targeting cognitive functioning. Technology-based interventions offer feelings of safety, fun, and satisfaction, and they also have the potential to improve CKD patients' health outcomes regarding their psychological well-being. The diverseness of technologies allows an approximation towards the identification of those types of technologies most frequently used, as well as the symptoms targeted. There was considerable heterogeneity in the types of technologies used for interventions in so few studies, making it difficult to draw conclusive findings with regard to their efficiency. In order to adequately assess the technology-based health interventions effect, future lines of research should consider designing non-pharmacological treatments for the improvement of cognitive and psychological symptoms in this type of patient.
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Affiliation(s)
- Alexandra-Elena Marin
- Department of Psychobiology, Faculty of Psychology and Logopedics, Universitat de València, 46010 Valencia, Spain
| | - Rosa Redolat
- Department of Psychobiology, Faculty of Psychology and Logopedics, Universitat de València, 46010 Valencia, Spain
| | - José-Antonio Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Patricia Mesa-Gresa
- Department of Psychobiology, Faculty of Psychology and Logopedics, Universitat de València, 46010 Valencia, Spain
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Tommel J, Evers AWM, van Hamersvelt HW, van Dijk S, Chavannes NH, Wirken L, Hilbrands LB, van Middendorp H. E-HEalth treatment in Long-term Dialysis (E-HELD): study protocol for a multicenter randomized controlled trial evaluating personalized Internet-based cognitive-behavioral therapy in dialysis patients. Trials 2022; 23:477. [PMID: 35672832 PMCID: PMC9172166 DOI: 10.1186/s13063-022-06392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Kidney failure and dialysis treatment have a large impact on a patient’s life. Patients experience numerous, complex symptoms and usually have multiple comorbid conditions. Despite the multitude of problems, patients often have priorities for improvement of specific aspects of their functioning, which would be helpful for clinicians to become informed of. This highlights a clear need for patient-centered care in this particular patient group, with routine screening as a vital element to timely recognize symptoms and tailored treatment to match individual patients’ needs and priorities. By also providing feedback on patient’s screening results to the patient itself, the patient is empowered to actively take control in one’s mostly uncontrollable disease process. The current paper describes the study design of a multicenter randomized controlled trial evaluating the effectiveness of the “E-HEealth treatment in Long-term Dialysis” (E-HELD) intervention. This therapist-guided Internet-based cognitive-behavioral therapy (ICBT) intervention is focused on and personalized to the myriad of problems that dialysis patients experience and prioritize. Methods After a screening procedure on adjustment problems, 130 eligible dialysis patients will be randomized to care as usual or the E-HELD intervention. Patients will complete questionnaires on distress (primary outcome measure), several domains of functioning (e.g., physical, psychological, social), potential predictors and mediators of treatment success, and the cost-effectiveness of the intervention, at baseline, 6-month follow-up, and 12-month follow-up. In addition, to take account of the personalized character of the intervention, the Personalized Priority and Progress Questionnaire (PPPQ) will be administered which is a personalized instrument to identify, prioritize, and monitor individual problems over time. Discussion The present study design will provide insight in the effectiveness of tailored ICBT in patients with kidney failure who are treated with dialysis. When proven effective, the screening procedure and the subsequent ICBT intervention could be implemented in routine care to detect, support, and treat patients struggling with adjustment problems. Trial registration NL63422.058.17 [Registry ID: METC-LDD] NL7160 [Netherlands Trial Register; registered on 16 July 2018]
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Nadort E, Schouten RW, Boeschoten RE, Smets Y, Chandie Shaw P, Vleming LJ, Dekker MJE, Westerman M, Hoogeveen EK, Bos WJW, Schouten M, Farhat K, Dekker FW, van Oppen P, Broekman BFP, Siegert CEH. Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial. Gen Hosp Psychiatry 2022; 75:46-53. [PMID: 35134703 DOI: 10.1016/j.genhosppsych.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. METHOD Chronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory - second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. RESULTS A total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference - 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. CONCLUSIONS Guided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Robbert W Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Rosa E Boeschoten
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Yves Smets
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
| | - Prataap Chandie Shaw
- Department of Nephrology, Haaglanden Medisch Centrum, Lijnbaan 32, 2512 VA, The Hague, the Netherlands.
| | - Louis Jean Vleming
- Department of Nephrology, HagaZiekenhuis, Els Borst-Eilersplein 275, 2545 AA The Hague, the Netherlands.
| | - Marijke J E Dekker
- Department of Nephrology, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands.
| | - Michiel Westerman
- Department of Nephrology, Franciscus Gasthuis & Vlietland Ziekenhuis, Kleiweg 500, 3045 PM Rotterdam, the Netherlands.
| | - Ellen K Hoogeveen
- Department of Nephrology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ s-Hertogenbosch, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Willem J W Bos
- Department of Internal Medicine, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Marcel Schouten
- Department of Nephrology, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, the Netherlands.
| | - Karima Farhat
- Department of Nephrology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC Haarlem, the Netherlands.
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Birit F P Broekman
- Department of Psychiatry, OLVG Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centre and GGZ inGeest, Oldenaller 1, 1081, HJ, Amsterdam, the Netherlands.
| | - Carl E H Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
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Gregg LP, Trombello JM, McAdams M, Hedayati SS. Diagnosis and Management of Depression in Patients With Kidney Disease. Semin Nephrol 2022; 41:505-515. [PMID: 34973695 DOI: 10.1016/j.semnephrol.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
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Affiliation(s)
- L Parker Gregg
- Selzman Institute for Kidney Health, Department of Medicine, Baylor College of Medicine, Houston, TX; Division of Nephrology, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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Eveleens Maarse BC, Chesnaye NC, Schouten R, Michels WM, Bos WJW, Szymczak M, Krajewska M, Evans M, Heimburger O, Caskey FJ, Wanner C, Jager KJ, Dekker FW, Meuleman Y, Schneider A, Torp A, Iwig B, Perras B, Marx C, Drechsler C, Blaser C, Wanner C, Emde C, Krieter D, Fuchs D, Irmler E, Platen E, Schmidt-Gürtler H, Schlee H, Naujoks H, Schlee I, Cäsar S, Beige J, Röthele J, Mazur J, Hahn K, Blouin K, Neumeier K, Anding-Rost K, Schramm L, Hopf M, Wuttke N, Frischmuth N, Ichtiaris P, Kirste P, Schulz P, Aign S, Biribauer S, Manan S, Röser S, Heidenreich S, Palm S, Schwedler S, Delrieux S, Renker S, Schättel S, Stephan T, Schmiedeke T, Weinreich T, Leimbach T, Stövesand T, Bahner U, Seeger W, Cupisti A, Sagliocca A, Ferraro A, Mele A, Naticchia A, Còsaro A, Ranghino A, Stucchi A, Pignataro A, De Blasio A, Pani A, Tsalouichos A, Antonio B, Di Iorio BR, Alessandra B, Abaterusso C, Somma C, D'alessandro C, Torino C, Zullo C, Pozzi C, Bergamo D, Ciurlino D, Motta D, Russo D, Favaro E, Vigotti F, Ansali F, Conte F, Cianciotta F, Giacchino F, Cappellaio F, Pizzarelli F, Greco G, Porto G, Bigatti G, Marinangeli G, Cabiddu G, Fumagalli G, Caloro G, Piccoli G, Capasso G, Gambaro G, Tognarelli G, Bonforte G, Conte G, Toscano G, Del Rosso G, Capizzi I, Baragetti I, Oldrizzi L, Gesualdo L, Biancone L, Magnano M, Ricardi M, Di Bari M, Laudato M, Sirico ML, Ferraresi M, Postorino M, Provenzano M, Malaguti M, Palmieri N, Murrone P, Cirillo P, Dattolo P, Acampora P, Nigro R, Boero R, Scarpioni R, Sicoli R, Malandra R, Savoldi S, Bertoli S, Borrelli S, Maxia S, Maffei S, Mangano S, Cicchetti T, Rappa T, Palazzo V, De Simone W, Schrander A, van Dam B, Siegert C, Gaillard C, Beerenhout C, Verburgh C, Janmaat C, Hoogeveen E, Hoorn E, Dekker F, Boots J, Boom H, Eijgenraam JW, Kooman J, Rotmans J, Jager K, Vogt L, Raasveld M, Vervloet M, van Buren M, van Diepen M, Chesnaye N, Leurs P, Voskamp P, Blankestijn P, van Esch S, Boorsma S, Berger S, Konings C, Aydin Z, Musiała A, Szymczak A, Olczyk E, Augustyniak-Bartosik H, Miśkowiec-Wiśniewska I, Manitius J, Pondel J, Jędrzejak K, Nowańska K, Nowak Ł, Szymczak M, Durlik M, Dorota S, Nieszporek T, Heleniak Z, Jonsson A, Blom AL, Rogland B, Wallquist C, Vargas D, Dimény E, Sundelin F, Uhlin F, Welander G, Hernandez IB, Gröntoft KC, Stendahl M, Svensson M, Evans M, Heimburger O, Kashioulis P, Melander S, Almquist T, Jensen U, Woodman A, McKeever A, Ullah A, McLaren B, Harron C, Barrett C, O'Toole C, Summersgill C, Geddes C, Glowski D, McGlynn D, Sands D, Caskey F, Roy G, Hirst G, King H, McNally H, Masri-Senghor H, Murtagh H, Rayner H, Turner J, Wilcox J, Berdeprado J, Wong J, Banda J, Jones K, Haydock L, Wilkinson L, Carmody M, Weetman M, Joinson M, Dutton M, Matthews M, Morgan N, Bleakley N, Cockwell P, Roderick P, Mason P, Kalra P, Sajith R, Chapman S, Navjee S, Crosbie S, Brown S, Tickle S, Mathavakkannan S, Kuan Y. Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study. Clin Kidney J 2021; 15:786-797. [PMID: 35371440 PMCID: PMC8967670 DOI: 10.1093/ckj/sfab261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.
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Affiliation(s)
| | - Nicholas C Chesnaye
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robbert Schouten
- Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands
| | - Wieneke M Michels
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Marie Evans
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olof Heimburger
- Department of Clinical Sciences Intervention and Technology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Fergus J Caskey
- Renal Unit, Southmead Hospital, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Kitty J Jager
- ERA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvette Meuleman
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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González-Flores CJ, García-García G, Lerma A, Pérez-Grovas H, Meda-Lara RM, Guzmán-Saldaña RME, Lerma C. Resilience: A Protective Factor from Depression and Anxiety in Mexican Dialysis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11957. [PMID: 34831713 PMCID: PMC8620979 DOI: 10.3390/ijerph182211957] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
Depression and anxiety are highly prevalent psychological disorders in end-stage renal disease (ESRD) that have a negative clinical impact. The purpose of our study was to identify factors associated with the presence of depression and anxiety, in a sample of ESRD patients treated with hemodialysis. We included 187 patients from two dialysis facilities, age 18-65 years. Beck's depression and anxiety inventories, KDQOL36 questionnaire, the cognitive distortion scale and the Mexican scale of resilience were used. Socio-demographic and clinical information was obtained from medical records. Depression was present in 143 (76.4%) patients. Patient with depression were older (33 (26-52) years vs. 30 (24.43) years, p = 0.025), had a lower education level (36% vs. 9%, p = 0.001), used more medications (67% vs. 36%, p = 0.001), had a comorbidity (75% vs. 41%, p = 0.001), and a higher proportion were waiting for a kidney transplant. Anxiety was present in 112 (59.8%) cases. By multivariate analysis, depression was independently associated with lower education, absence of previous kidney transplant, anxiety, higher cognitive distortion, lower psychological resilience, and lower quality of life scores. In conclusion, lower psychological resilience, lower education level, and higher cognitive distortions are factors associated with depression and anxiety in ESRD patients.
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Affiliation(s)
| | - Guillermo García-García
- Nephrology Department, Civil Hospital de Guadalajara Fray Antonio Alcalde, Guadalajara 44280, Mexico;
| | - Abel Lerma
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico; (A.L.); (R.M.E.G.-S.)
| | | | - Rosa M. Meda-Lara
- Departments of Basic Psychology and Medical Clinics, Health Sciences Center, University of Guadalajara, Guadalajara 44340, Mexico;
| | - Rebeca M. E. Guzmán-Saldaña
- Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, San Juan Tilcuautla 42160, Mexico; (A.L.); (R.M.E.G.-S.)
| | - Claudia Lerma
- National Institute of Cardiology Ignacio Chávez, México City 14080, Mexico;
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The efficacy of web or mobile-based interventions to alleviate emotional symptoms in people with advanced cancer: a systematic review and meta-analysis. Support Care Cancer 2021; 30:3029-3042. [PMID: 34735601 DOI: 10.1007/s00520-021-06496-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This review aims to critically evaluate the efficacy of web or mobile-based (WMB) interventions impacting emotional symptoms in patients with advanced cancer. METHOD Articles published from 1991 to 2019 were identified using PubMed, PsycINFO, CINAHL, and Scopus. Only interventions involving adults with advanced cancer using a WMB intervention to manage emotional symptoms were included. Risk of bias was assessed using ROBINS-I and ROB2 tools. Studies that reported mean symptom scores were pooled using a random-effects model, and standardized mean difference (SMD) and 95% CIs were calculated. RESULTS Twenty-three of the 1177 screened studies met the inclusion criteria, and a total sample of 2558 patients were included. The sample was 57% female, and 33% had advanced cancer with mean age of 57.15 years. Thirteen studies evaluated anxiety, nineteen evaluated depression, and eleven evaluated distress. Intervention components included general information, tracking, communication, multimedia choice, interactive online activities, tailoring/feedback, symptom management support content, and self-monitoring. Overall pooled results showed that WMB interventions' effects on decreasing anxiety (SMD - 0.20, - 0.45 to 0.05, I2 = 72%), depression (SMD - 0.10, - 0.30 to 0.11, I2 = 73%), and distress (SMD - 0.20, - 0.47 to 0.06, I2 = 60%) were not significant for randomized controlled trials (RCTs). In contrast, WMB interventions significantly decreased symptoms of anxiety (p = .002) in a sub-group analysis of non-RCTs. CONCLUSION This meta-analysis demonstrated that WMB interventions were not efficacious in alleviating emotional symptoms in adults with advanced cancer. Considering the diversity of interventions, the efficacy of WMB interventions and its impacts on emotional symptoms should be further explored.
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Látos M, Lázár G, Ondrik Z, Szederkényi E, Hódi Z, Horváth Z, Csabai M. Positive Psychology Intervention to Improve Recovery after Renal Transplantation: A Randomized Controlled Trial. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09515-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gregg LP, Hedayati SS. Pharmacologic and psychological interventions for depression treatment in patients with kidney disease. Curr Opin Nephrol Hypertens 2020; 29:457-464. [PMID: 32701597 PMCID: PMC7735461 DOI: 10.1097/mnh.0000000000000629] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW It remains controversial whether existing therapies, including pharmacologic and psychological interventions, are effective for treatment of depression in patients with chronic kidney disease (CKD) and end-stage kidney disease. RECENT FINDINGS Most studies of depression treatment were underpowered or uncontrolled. The CKD Antidepressant Sertraline Trial showed no benefit of a serotonin-selective reuptake inhibitor (SSRI), sertraline, over double-blind matched placebo for the treatment of depressive symptoms in patients with nondialysis CKD. A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression showed improvement in depressive symptoms from baseline in both groups and a marginal benefit of sertraline over CBT that was of unclear clinical significance, given the lack of an active control group. SSRIs are associated with poor tolerability in clinical trials and serious adverse outcomes in large retrospective studies. SUMMARY Although the data do not support unlimited use of SSRIs in patients with CKD or end-stage kidney disease, it is reasonable to initiate a cautious trial of sertraline while closely monitoring for depressive symptom improvement and adverse effects. CBT is a low-risk, possibly effective intervention to treat major depressive disorder in patients with kidney disease who have access to such treatments.
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Affiliation(s)
- L. Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Renal Section, Medical Service, VA North Texas Health Care System, Dallas, TX
| | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Ahmad Othman A, Wan Jaafar WM, Zainuddin ZN, Mohamad Yusop Y. Effectiveness of cognitive behaviour therapy on depression among haemodialysis patients: A systematic review of literature. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1794680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Akmarina Ahmad Othman
- Counselor Education and Counseling Psychology, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor 43400 UPM, Malaysia
| | - Wan Marzuki Wan Jaafar
- Counselor Education and Counseling Psychology, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor 43400 UPM, Malaysia
| | - Zaida Nor Zainuddin
- Counselor Education and Counseling Psychology, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor 43400 UPM, Malaysia
| | - Yusni Mohamad Yusop
- Counselor Education and Counseling Psychology, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor 43400 UPM, Malaysia
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Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CDF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem 2020; 28:e3327. [PMID: 32696925 PMCID: PMC7365615 DOI: 10.1590/1518-8345.3641.3327] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE to verify the association between the health-related quality of life of chronic renal patients on hemodialysis with sociodemographic, clinical, depression and medication adherence characteristics. METHOD a cross-sectional study with 183 chronic renal patients undergoing hemodialysis in the state of Rio Grande do Sul, Brazil. A sociodemographic and clinical questionnaire, Kidney Disease and Quality of Life Short-Form, Beck Depression Inventory and Morisky Medication Adherence Scale - eight items were used. Among the variables, comorbidities, complications of kidney disease and intercurrences during and after hemodialysis were evaluated. The analysis was performed with descriptive and analytical statistics. RESULTS 55.2% of the patients were 60 years old or older, 35.0% were hypertensive, with regular quality of life, average of 62.61. Scores below average in the dimensions of quality of life were mainly associated with repetitive infections and edema as complications of the disease, pain during hemodialysis and weakness afterwards. Low drug adherence resulted in a worse quality of life, impacting ten of the 20 dimensions evaluated and depression in all, except for patient satisfaction. CONCLUSION reduced quality of life in this population is associated with depressive symptoms, complications such as repetitive infections, pain and anemia, weakness after the dialysis session and low medication adherence. Actions aimed at changing these factors can promote well-being.
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Affiliation(s)
- Carolina Renz Pretto
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijui, RS, Brazil
| | - Eliane Roseli Winkelmann
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijui, RS, Brazil
| | | | - Dulce Aparecida Barbosa
- Departamento de Enfermagem Clínica e Cirúrgica, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Christiane de Fátima Colet
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijui, RS, Brazil
| | - Eniva Miladi Fernandes Stumm
- Departamento de Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijui, RS, Brazil
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Schneider L, Hadjistavropoulos H, Dear B, Titov N. Efficacy of internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial. Internet Interv 2020; 21:100324. [PMID: 32455120 PMCID: PMC7235608 DOI: 10.1016/j.invent.2020.100324] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/29/2022] Open
Abstract
Depression and anxiety are common among people who have experienced an acute coronary event (e.g., heart attack). Multidisciplinary cardiac rehabilitation programs often focus on reducing risk factors associated with future cardiac events, however, mental health interventions are not routinely available. Given known difficulties with access to mental health treatment, the present study sought to explore the efficacy and acceptability of an Internet-delivered cognitive behavioural therapy program (Cardiac Wellbeing Course) among participants who experienced an acute coronary event. The five-lesson course was delivered over eight weeks and was provided with brief weekly contact, via telephone and secure email with a guide. Participants were randomized to the Cardiac Wellbeing Course (n = 25) or waiting-list control group (n = 28). Symptoms were assessed at pre-treatment, post-treatment, and four-week follow-up. Completion rates (84%) and satisfaction ratings (95%) were high. Statistically significant between-group improvements were observed for the treatment group on primary measures of general anxiety (Cohen's d = 1.62; 67% reduction), depression (Cohen's d = 1.09; 61% reduction), and physical activity levels (Cohen's d = 0.27; 70% increase). Statistically significant improvements were also observed on secondary measures of distress (Cohen's d = 0.98; 51% reduction), cardiac anxiety (Cohen's d = 0.92; 34% reduction), and mental-health quality of life (Cohen's d = 0.23; 24% improvement). The changes were maintained at four-week follow-up. The current findings add to the existing literature and highlight the potential of Internet-delivered cognitive behavioural therapy programs among participants who have experienced an acute coronary event.
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Affiliation(s)
- L.H. Schneider
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
| | - H.D. Hadjistavropoulos
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
- Corresponding author.
| | - B.F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
| | - N. Titov
- eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
- MindSpot Clinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
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Nadort E, Schouten RW, Dekker FW, Honig A, van Oppen P, Siegert CEH. The (cost) effectiveness of guided internet-based self-help CBT for dialysis patients with symptoms of depression: study protocol of a randomised controlled trial. BMC Psychiatry 2019; 19:372. [PMID: 31775685 PMCID: PMC6881986 DOI: 10.1186/s12888-019-2363-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Only a minority of dialysis patients with depressive symptoms are diagnosed and receive treatment. Depressive symptoms are highly prevalent in this population and are associated with adverse clinical outcomes. Underlying factors for this undertreatment may be the lack of evidence for the safety and effectivity of antidepressant medication, the reluctance of patients to adhere to antidepressant medication, the lack of mental healthcare provision in somatic healthcare environments and end-stage renal disease (ESRD) related physical limitations that complicate face-to-face psychotherapy. Guided Internet-based self-help treatment has demonstrated to be effective for depressive symptoms in other chronic patient populations and may overcome these barriers. The aim of this study is to investigate the (cost) effectiveness of a guided Internet-based self-help intervention for symptoms of depression in dialysis patients. METHODS This study is a cluster randomized controlled trial (RCT) that investigates the effectiveness of a 5-week Internet-based self-help Problem Solving Therapy (PST) for depressive symptoms in dialysis patients. Depressive symptoms will be measured using the Beck Depression Inventory - second edition (BDI-II), with a cut-off score of ≥10. We aim to include 206 dialysis patients with depressive symptoms who will be cluster randomized to the intervention or the Care as Usual (CAU) control group. Secondary outcomes will include anxiety symptoms, quality of life, economic costs and clinical outcomes, such as inflammatory factors and hair cortisol levels. Assessments will take place at baseline (T0), 2 weeks after intervention (T1) and 6 months (T2), 12 months (T3) and 18 months (T4) after intervention. The control group will be measured at the same time points. Analysis will be based on the intention-to-treat principle. Mixed models will be used to assess the changes within each condition between pre-treatment and post-treatment. DISCUSSION If demonstrated to be (cost) effective, Internet-based PST will offer new possibilities to treat dialysis patients with depressive symptoms and to improve their quality of care. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.
| | - Robbert W. Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Friedo W. Dekker
- 0000000089452978grid.10419.3dDepartment of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Adriaan Honig
- grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Patricia van Oppen
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ,Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, Netherlands
| | - Carl E. H. Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands
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Ng CZ, Tang SC, Chan M, Tran BX, Ho CS, Tam WW, Ho RC. A systematic review and meta-analysis of randomized controlled trials of cognitive behavioral therapy for hemodialysis patients with depression. J Psychosom Res 2019; 126:109834. [PMID: 31525637 DOI: 10.1016/j.jpsychores.2019.109834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to examine the efficacy of cognitive behavioral therapy (CBT) for hemodialysis patients with comorbid depression and to identify which other aspects, including anxiety and quality of life, can be improved through intervention. METHODS A systematic literature review was performed using multiple databases (PubMed, EMBase, PsycINFO, CENTRAL). The inclusion criteria included randomized controlled trials (RCTs) of CBT conducted in hemodialysis patients with depression. Study reporting quality was assessed with the Cochrane tool and Review Manager version 5.3 was used to obtain pooled results. RESULTS Eight RCTs, with a total sample size of 540 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant improvements in depression (standardized mean differences [SMD] = -0.68, 95% confidence interval [CI] (-0.94 to -0.42), P < .001), anxiety (SMD = -0.99, 95%CI (-1.99 to 0.00), P = .05) and quality of life (SMD = 0.34, 95%CI (0.13 to 0.54), P < .001). CONCLUSIONS The results of this meta-analysis showed that CBT could have an effective role in reducing symptoms of depression and anxiety as well as improving quality of life in hemodialysis patients with comorbid depression.
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Affiliation(s)
- Chong Zheng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sydney C Tang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Meanne Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Health System, Singapore
| | - Wilson W Tam
- Alice Lee School of Nursing, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore; Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, 119228, Singapore; Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam; Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei, Anhui 235000, China.
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19
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Wen X, Wang Y, Zhao Q, Zhang H, Shi H, Wang M, Lu P. Nonpharmacological Interventions for Depressive Symptoms in End-Stage Renal Disease: A Systematic Review. West J Nurs Res 2019; 42:462-473. [PMID: 31248356 DOI: 10.1177/0193945919857540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depressive symptoms are common in patients with end-stage renal disease, which can affect treatment and prognosis. We aimed to evaluate the effects of nonpharmacological interventions for depressive symptoms in end-stage renal disease. Eligible studies were identified using PubMed, Web of Science, the Cochrane Library, Embase, and PsycNET (up to March 2019). We identified 24 studies including 1,376 patients. We found that psychological intervention (-0.60, 95% confidence interval [CI] = [-0.87, -0.33]), exercise (-1.13, 95% CI = [-1.56, -0.69]), and manual acupressure (-0.26, 95% CI = [-0.50, 0.03]) were associated with a significant effect on depressive symptoms. However, few studies reported adverse events, and conclusions about safety should be drawn cautiously. While the available data show that nonpharmacological interventions are potential strategies to alleviate depressive symptoms of patients with end-stage renal disease, recommendation of the most efficacious interventions for this population will require future randomized controlled trials with large-scale, long-term intervention.
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Affiliation(s)
- Xin Wen
- Jilin University, Changchun, China
| | - Yu Wang
- Jilin University, Changchun, China
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20
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Chilcot J, Hudson JL. Is successful treatment of depression in dialysis patients an achievable goal? Semin Dial 2018; 32:210-214. [PMID: 30418698 DOI: 10.1111/sdi.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna L Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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21
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Cassidy BP, Getchell LE, Harwood L, Hemmett J, Moist LM. Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review. Can J Kidney Health Dis 2018; 5:2054358118803322. [PMID: 30542621 PMCID: PMC6236635 DOI: 10.1177/2054358118803322] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE OF REVIEW Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients. SOURCES OF INFORMATION PubMed and Google Scholar. METHODS A narrative review was performed using the main terms "chronic kidney disease," "CKD," "dialysis," "review," "decision-making," "decision aids," "education," and "barriers." Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed. KEY FINDINGS Eight common themes were identified as influencers for decision making. "Patient-focused" themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and "clinician-focused" themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines. LIMITATIONS This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable. IMPLICATIONS Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.
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Affiliation(s)
- Brendan P. Cassidy
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Leah E. Getchell
- Kidney, Dialysis and Transplantation
Program, ICES Western, London, ON, Canada
| | - Lori Harwood
- Renal Services, London Health Sciences
Centre, London, ON, Canada
| | - Juliya Hemmett
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Louise M. Moist
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
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22
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Dear BF, Fogliati VJ, Fogliati R, Gandy M, McDonald S, Talley N, Holtmann G, Titov N, Jones M. Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): A feasibility open trial. J Psychosom Res 2018; 108:61-69. [PMID: 29602327 DOI: 10.1016/j.jpsychores.2018.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/18/2022]
Abstract
Many people with functional gastrointestinal disorders (FGIDs) face significant barriers in accessing psychological treatments that are known to reduce symptoms and their psychological sequelae. This study examined the feasibility and initial outcomes of a transdiagnostic and internet-delivered cognitive behaviour therapy (iCBT) intervention, the Chronic Conditions Course, for adults with functional gastrointestinal disorders (FGIDs). A single-group feasibility open trial design was employed and administered to twenty seven participants. The course ran for 8 weeks and was provided with weekly contact from a Clinical Psychologist. Seventy percent of participants completed the course within the 8 weeks and 81.5% provided data at post-treatment. High levels of satisfaction were observed and relatively little clinician time (M = 42.70 min per participant; SD = 46.25 min) was required. Evidence of clinical improvements in FGID symptoms (ds ≥ 0.46; avg. improvement ≥21%), anxiety symptoms (ds ≥ 0.99; avg. improvement ≥42%), and depression symptoms (ds ≥ 0.75; avg. improvement ≥35%) were observed, which either maintained or continued to improve to 3-month follow-up. Evidence of improvement was also observed in pain catastrophising and mental-health related quality of life, but not physical-health related quality of life. These findings highlight the potential value of transdiagnostic internet-delivered programs for adults with FGIDs and support for the conduct of larger-scale controlled studies.
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Affiliation(s)
- B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - V J Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - R Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - S McDonald
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - N Talley
- Faculty of Health & Medicine, University of Newcastle, Newcastle, Australia
| | - G Holtmann
- Princess Alexandra Hospital and Translational Research Institute, Brisbane, Australia
| | - N Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - M Jones
- Faculty of Health & Medicine, University of Newcastle, Newcastle, Australia; Department of Psychology, Macquarie University, Sydney, Australia
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23
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Vork DL, Schneekloth TD, Bartley AC, Vaughan LE, Lapid MI, Jowsey-Gregoire SG, El-Zoghby ZM, Herrmann SM, Tran CL, Albright RC, Hickson LJ. Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization. Mayo Clin Proc 2018; 93:321-332. [PMID: 29502562 PMCID: PMC5854145 DOI: 10.1016/j.mayocp.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/23/2017] [Accepted: 12/05/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy. PATIENTS AND METHODS Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year. RESULTS Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups. CONCLUSION Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.
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Affiliation(s)
| | | | - Adam C Bartley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lisa E Vaughan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | | | - Ziad M El-Zoghby
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Cheryl L Tran
- Division of Pediatric Nephrology, Department of Pediatrics, Mayo Clinic, Rochester, MN
| | | | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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24
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Hudson JL, Moss-Morris R, Norton S, Picariello F, Game D, Carroll A, Spencer J, McCrone P, Hotopf M, Yardley L, Chilcot J. Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial. J Psychosom Res 2017; 102:61-70. [PMID: 28992899 DOI: 10.1016/j.jpsychores.2017.09.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychological distress is prevalent in haemodialysis (HD) patients yet access to psychotherapy remains limited. This study assessed the feasibility and acceptability of online cognitive-behavioural therapy (CBT) tailored for HD patients, with or without therapist support, for managing psychological distress. METHODS This feasibility randomised controlled trial recruited patients from a UK HD centre. Following psychological distress screens, patients with mild-moderate psychological distress (Patient Health Questionnaire PHQ-9; score: 5-19 and/or Generalised Anxiety Disorder; GAD-7 score: 5-14) who met remaining inclusion criteria were approached for consent. Consenters were individually randomised (1:1) to online-CBT or online-CBT plus three therapist support calls. Outcomes included recruitment, retention, and adherence rates. Exploratory change analyses were performed for: psychological distress, quality of life (QoL), illness perceptions, and costs. The statistician was blinded to allocation. RESULTS 182 (44%) out of 410 patients approached completed psychological distress screens. 26% found screening unacceptable; a further 30% found it unfeasible. Psychological distress was detected in 101 (55%) patients, 60 of these met remaining inclusion criteria. The primary reason for ineligibility was poor computer literacy (N=17, 53%). Twenty-five patients were randomised to the supported (N=18) or unsupported arm (N=7); 92% were retained at follow-up. No differences in psychological distress or cost-effectiveness were observed. No trial adverse events occurred. CONCLUSION Online CBT appears feasible but only for computer literate patients who identify with the label psychological distress. A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible. ClinicalTrials.gov Identifier: NCT02352870.
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Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | | | | | - Jonathan Spencer
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
| | - Lucy Yardley
- Psychology Department, University of Southampton, UK; Nuffield Department of Primary Care and Health Sciences, University of Oxford, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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