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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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Yang H, Qi L, Pei D. Effect of psychosocial interventions for depression in adults with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2024; 25:17. [PMID: 38200465 PMCID: PMC10782786 DOI: 10.1186/s12882-023-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) treated with dialysis are frequently affected by depression. Psychotherapy has been reported to decrease depressive symptoms in various chronic diseases and is a potential treatment option for depression. We aimed to perform a systematic review and meta-analysis to evaluate the effect of psychotherapy on depression in adults with CKD. METHODS We searched MEDLINE, Embase, Web of Science, and Cochrane for published studies up to October 31, 2023. Two investigators independently reviewed the included studies and extracted relevant data. Randomized controlled trials (RCTs) assessing the impact of interventions that provide psychological, emotional, or social support without the use of pharmacological substances on depressive symptoms in people with CKD were included and summarized. Scores on different tools for depressive assessment and quality of life were pooled. RESULTS A total of 19 RCTs published between 2004 and 2023 were included and analyzed. The weighted mean difference (WMD) for all included studies with regard to depression was - 2.32 (95%CI=-3.83, -0.80, P = 0.003). The WMD for Beck Depression Inventory (BDI) score of depression was - 3.27 (95%CI=-7.81, 1.27, P = 0.158) with significant heterogeneity (I2 = 95.1%). Significant WMD was detected for the Hospital Anxiety and Depression Scale (HADS) tool: WMD=-1.90, 95%CI=-2.91, -0.90, P < 0.001. The WMD for all included studies regarding quality of life was 1.21 (95%CI=-0.51, 2.93, P = 0.168). The WMD for Kidney Disease Quality of Life Short Form (KDQOL-SF) score was 4.55 (95%CI = 0.50, 8.60, P = 0.028). The WMD for SF-36 score was 0.02 (95%CI=-10.33, 10.36, P = 0.998). Significant difference on outcomes of S-PRT scale was observed (WMD = 2.42, 95%CI = 1.07, 3.76, P < 0.001). CONCLUSIONS Psychosocial interventions probably reduce the depression level among CKD patients. Preliminary evidence suggests that psychosocial interventions might be beneficial for the quality of life in CKD patients. Our results provide medical facilities with an evidence-based basis for establishing psychosocial interventions in kidney care settings.
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Affiliation(s)
- Hui Yang
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Li Qi
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China.
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Chen H, Zhu L, Chan WS, Cheng KFK, Vathsala A, He H. The effectiveness of a psychoeducational intervention on health outcomes of patients undergoing haemodialysis: A randomized controlled trial. Int J Nurs Pract 2022:e13123. [DOI: 10.1111/ijn.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/23/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Hui‐Chen Chen
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine National University of Singapore Singapore
- National University Health System Singapore
| | - Lixia Zhu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine National University of Singapore Singapore
- National University Health System Singapore
| | | | - Kin Fong Karis Cheng
- Graduate School of Medicine, Global Nursing Research Centre The University of Tokyo Tokyo Japan
| | - A. Vathsala
- Division of Nephrology National University Hospital Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Hong‐Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine National University of Singapore Singapore
- National University Health System Singapore
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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: 3] [Impact Index Per Article: 1.5] [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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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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Brief Mindfulness Intervention vs. Health Enhancement Program for Patients Undergoing Dialysis: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9060659. [PMID: 34205915 PMCID: PMC8228217 DOI: 10.3390/healthcare9060659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Between 20–50% of patients undergoing maintenance dialysis for end-stage kidney disease experience symptoms of depression and/or anxiety, associated with increased mortality, greater health care utilization, and decreased quality of life. It is unknown whether mindfulness-based interventions can improve depression and anxiety symptoms in patients receiving this treatment. Methods: We conducted an 8-week multicenter randomized controlled trial comparing a brief mindfulness intervention (BMI) vs. an active control (Health Enhancement Program [HEP]) in 55 patients receiving dialysis with symptoms of depression and/or anxiety. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) depression scores, with a primary analysis in participants with baseline PHQ-9 ≥ 10, and a secondary analysis including all participants. The secondary outcome was change in Generalized Anxiety Disorder-7 (GAD-7) anxiety scores with corresponding primary and secondary analyses. Results: Both BMI and HEP reduced depressive symptoms, with no difference between trial arms (PHQ-9 change = −7.0 vs. −6.1, p = 0.62). BMI was more effective than HEP in reducing anxiety (GAD-7 change = −8.7 vs. −1.4, p = 0.01). Secondary analyses revealed no differences between arms. Conclusions: For patients undergoing dialysis, both BMI and HEP may be helpful interventions for depression symptoms, and BMI may be superior to HEP for anxiety symptoms. Mindfulness-based and other psychosocial interventions may be further evaluated in those undergoing dialysis as treatment options for symptoms of depression and anxiety.
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Chopra P, Ayers CK, Antick JR, Kansagara D, Kondo K. The Effectiveness of Depression Treatment for Adults with ESKD: A Systematic Review. KIDNEY360 2021; 2:558-585. [PMID: 35369008 PMCID: PMC8785990 DOI: 10.34067/kid.0003142020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
Adults with dialysis-dependent ESKD experience higher rates of depression than the general population, yet efficacy of depression treatments in this population is not well understood. We conducted a systematic review of the benefits and harms of depression treatment in adults with ESKD. We searched multiple data sources through June 2020 for English-language, controlled trials that compared interventions for depression in adults with ESKD to another intervention, placebo, or usual care, and reported depression treatment-related outcomes. Observational studies were included for harms. Two investigators independently screened all studies using prespecified criteria. One reviewer abstracted data on study design, interventions, implementation characteristics, and outcomes, and a second reviewer provided confirmation. Two reviewers independently assessed study quality and resolved any discords through discussion or a third reviewer. Strength of evidence (SOE) was assessed and agreed upon by review-team consensus. We qualitatively analyzed the data and present syntheses in text and tables. We included 26 RCTs and three observational studies. SSRIs were the most studied type of drug and the evidence was largely insufficient. We found moderate SOE that long-term, high-dose vitamin D3 is ineffective for reducing depression severity. Cognitive behavioral therapy is more effective than (undefined) psychotherapy and placebo for depression improvement and quality of life (low SOE), and acupressure is more effective than usual care or sham acupressure in reducing depression severity (low SOE). There is limited research evaluating treatment for depression in adults with ESKD, and existing studies may not be generalizable to adults in the United States. Studies suffer from limitations related to methodologic quality or reporting. More research replicating studies of promising interventions in US populations, with larger samples, is needed. Systematic Review registry name and registration number: PROSPERO, CRD42020140227.
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Affiliation(s)
- Pavan Chopra
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Chelsea K. Ayers
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer R. Antick
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon,Legacy Good Samaritan Medical Center, Portland, Oregon
| | - Devan Kansagara
- Department of Medicine, Oregon Health and Science University, Portland, Oregon,Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Karli Kondo
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Research Integrity Office, Oregon Health and Science University, Portland, Oregon
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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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Ling C, Evans D, Zhang Y, Luo J, Hu Y, Ouyang Y, Tang J, Kuang Z. The effects of cognitive behavioural therapy on depression and quality of life in patients with maintenance haemodialysis: a systematic review. BMC Psychiatry 2020; 20:369. [PMID: 32664880 PMCID: PMC7362428 DOI: 10.1186/s12888-020-02754-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/23/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL). Although cognitive behavioural therapy (CBT) has been shown to improve depressive symptoms and QoL in other chronic illness, there is uncertainty in terms of the effectiveness of CBT in HD patients with depression or depressive symptoms. METHODS All randomised controlled trials relevant to the topic were retrieved from the following databases: CINHAL, MEDLINE, PubMed, PsycINFO and CENTRAL. The grey literature, specific journals, reference lists of included studies and trials registers website were also searched. Data was extracted or calculated from included studies that had measured depression and quality of life using valid and reliable tools -this included mean differences or standardised mean differences and 95% confidence intervals. The Cochrane risk of bias tool was used to identify the methodological quality of the included studies. RESULTS Six RCTs were included with varying methodological quality. Meta-analysis was undertaken for 3 studies that employed the CBT versus usual care. All studies showed that the depressive symptoms significantly improved after the CBT. Furthermore, CBT was more effective than usual care (MD = - 5.28, 95%CI - 7.9 to - 2.65, P = 0.37) and counselling (MD = - 2.39, 95%CI - 3.49 to - 1.29), while less effective than sertraline (MD = 2.2, 95%CI 0.43 to 3.97) in alleviating depressive symptoms. Additionally, the CBT seems to have a beneficial effect in improving QoL when compared with usual care, while no significant difference was found in QoL score when compared CBT with sertraline. CONCLUSIONS CBT may improve depressive symptoms and QoL in HD patients with comorbid depressive symptoms. However, more rigorous studies are needed in this field due to the small quantity and varied methodological quality in the identified studies.
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Affiliation(s)
- Chen Ling
- Department of Nephrology, Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800, People's Republic of China. .,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
| | - Debra Evans
- grid.19822.300000 0001 2180 2449Birmingham City University, City South Campus, Faculty of Health, Education and Life Sciences, 15 Bartholomew Row, Birmingham, B5 5JU UK
| | - Yunfang Zhang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China ,grid.284723.80000 0000 8877 7471The Third School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
| | - Jianying Luo
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yanping Hu
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Yuxia Ouyang
- grid.284723.80000 0000 8877 7471Nursing Department, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Jiamin Tang
- grid.284723.80000 0000 8877 7471Department of Nephrology, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 22 Baohua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
| | - Ziqiao Kuang
- grid.284723.80000 0000 8877 7471Department of Breast Surgery, Huadu Hospital, Southern Medical University (People’s Hospital of Huadu District), 48 Xinhua Road, Huadu District, Guangzhou, 510800 People’s Republic of China
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Natale P, Palmer SC, Ruospo M, Saglimbene VM, Rabindranath KS, Strippoli GFM. Psychosocial interventions for preventing and treating depression in dialysis patients. Cochrane Database Syst Rev 2019; 12:CD004542. [PMID: 31789430 PMCID: PMC6886341 DOI: 10.1002/14651858.cd004542.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review first published in 2005. OBJECTIVES To assess the effect of using psychosocial interventions versus usual care or a second psychosocial intervention for preventing and treating depression in patients with ESKD treated with dialysis. SEARCH METHODS We searched Cochrane Kidney and Transplant's Register of Studies up to 21 June 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. We assessed effects of interventions on changes in mental state (depression, anxiety, cognition), suicide, health-related quality of life (HRQoL), withdrawal from dialysis treatment, withdrawal from intervention, death (any cause), hospitalisation and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess evidence certainty. We estimated treatment effects using random-effects meta-analysis. Results for continuous outcomes were expressed as a mean difference (MD) or as a standardised mean difference (SMD) when investigators used different scales. Dichotomous outcomes were expressed as risk ratios. All estimates were reported together with 95% confidence intervals (CI). MAIN RESULTS We included 33 studies enrolling 2056 participants. Twenty-six new studies were added to this 2019 update. Seven studies originally excluded from the 2005 review were included as they met the updated review eligibility criteria, which have been expanded to include RCTs in which participants did not meet criteria for depression as an inclusion criterion. Psychosocial interventions included acupressure, cognitive-behavioural therapy, counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice-recording of a psychological intervention. The duration of study follow-up ranged between three weeks and one year. Studies included between nine and 235 participants. The mean study age ranged between 36.1 and 73.9 years. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies respectively. One study reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in seven studies. Twelve studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and 21 studies were at low risk of other potential sources of bias. Cognitive behavioural therapy probably improves depressive symptoms measured using the Beck Depression Inventory (4 studies, 230 participants: MD -6.10, 95% CI -8.63 to -3.57), based on moderate certainty evidence. Cognitive behavioural therapy compared to usual care probably improves HRQoL measured either with the Kidney Disease Quality of Life Instrument Short Form or the Quality of Life Scale, with a 0.5 standardised mean difference representing a moderate effect size (4 studies, 230 participants: SMD 0.51, 95% CI 0.19 to 0.83) , based on moderate certainty evidence. Cognitive behavioural therapy may reduce major depression symptoms (one study) and anxiety, and increase self-efficacy (one study). Cognitive behavioural therapy studies did not report hospitalisation. We found low-certainty evidence that counselling may slightly reduce depressive symptoms measured with the Beck Depression Inventory (3 studies, 99 participants: MD -3.84, 95% CI -6.14 to -1.53) compared to usual care. Counselling reported no difference in HRQoL (one study). Counselling studies did not measure risk of major depression, suicide, or hospitalisation. Exercise may reduce or prevent major depression (3 studies, 108 participants: RR 0.47, 95% CI 0.27 to 0.81), depression of any severity (3 studies, 108 participants: RR 0.69, 95% CI 0.54 to 0.87) and improve HRQoL measured with Quality of Life Index score (2 studies, 64 participants: MD 3.06, 95% CI 2.29 to 3.83) compared to usual care with low certainty. With moderate certainty, exercise probably improves depression symptoms measured with the Beck Depression Inventory (3 studies, 108 participants: MD -7.61, 95% CI -9.59 to -5.63). Exercise may reduce anxiety (one study). No exercise studies measured suicide risk or withdrawal from dialysis. We found moderate-certainty evidence that relaxation techniques probably reduce depressive symptoms measured with the Beck Depression Inventory (2 studies, 122 participants: MD -5.77, 95% CI -8.76 to -2.78). Relaxation techniques reported no difference in HRQoL (one study). Relaxation studies did not measure risk of major depression or suicide. Spiritual practices have uncertain effects on depressive symptoms measured either with the Beck Depression Inventory or the Brief Symptom Inventory (2 studies, 116 participants: SMD -1.00, 95% CI -3.52 to 1.53; very low certainty evidence). No differences between spiritual practices and usual care were reported on anxiety (one study), and HRQoL (one study). No study of spiritual practices evaluated effects on suicide risk, withdrawal from dialysis or hospitalisation. There were few or no data on acupressure, telephone support, meditation and adverse events related to psychosocial interventions. AUTHORS' CONCLUSIONS Cognitive behavioural therapy, exercise or relaxation techniques probably reduce depressive symptoms (moderate-certainty evidence) for adults with ESKD treated with dialysis. Cognitive behavioural therapy probably increases health-related quality of life. Evidence for spiritual practices, acupressure, telephone support, and meditation is of low certainty . Similarly, evidence for effects of psychosocial interventions on suicide risk, major depression, hospitalisation, withdrawal from dialysis, and adverse events is of low or very low certainty.
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Affiliation(s)
- Patrizia Natale
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Marinella Ruospo
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Valeria M Saglimbene
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | | | - Giovanni FM Strippoli
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
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Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender. Clin Exp Nephrol 2019; 24:63-72. [PMID: 31544220 DOI: 10.1007/s10157-019-01794-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Depression is common in chronic kidney disease (CKD) patients and associated with significant increase in morbidity and mortality. In recent years, a relationship between vitamin D deficiency and depression has been shown. The aim of this study is to investigate the relationship between 25-hydroxy (OH) vitamin D and depression in hemodialysis patients. METHODS A total of 140 patients were included in the study. Hamilton depression scale (HAM-D) was completed by all patients. 25(OH) vitamin D levels were compared between patients with and without depressive symptoms. RESULTS Patients who had depressive symptoms had significantly lower 25(OH) vitamin D levels (13.70 [24.3-8.25] vs. 18.20 [29.2-11.7] ng/mL, p = 0.016). HAM-D score showed significant association with gender (p = 0.011) and 25(OH) vitamin D level (p = 0.011). Univariate logistic regression analysis showed that males had lower risk of depression by a ratio of 61.1% (OR 0.389, p = 0.012) and vitamin D-deficient patients had 2.88 times greater risk of depression compared to non-deficient patients (OR 2.885, p = 0.013). Multivariate logistic regression analysis showed that males had 53.7% less risk of depression (OR 0.463, p = 0.046) and vitamin D-deficient patients had 2.39 times greater risk of depression (OR 2.397, p = 0.047). When evaluated by gender, univariate logistic regression analysis showed that 25(OH) vitamin D and other variables were not associated with depression in females (p > 0.05), while only vitamin D level had a significant effect on depression in males (OR 8.207, p = 0.008). CONCLUSIONS We found a significant association between vitamin D level and depressive symptoms in hemodialysis patients. When analyzed according to gender, this association was found to stand independent of other variables only in males.
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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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