Abel Lerma1,2, Héctor Perez-Grovas3, Luis Bermudez4, María L Peralta-Pedrero5, Rebeca Robles-García2, Claudia Lerma6. 1. University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico. 2. Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico. 3. Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico. 4. London Medical, Medical and Equipment Services, Distrito Federal, Mexico. 5. Coordination of High Specialty Medical Units, Mexican Institute of Social Security, Distrito Federal, Mexico. 6. Department of Electromechanical Instrumentation, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico.
Abstract
OBJECTIVES: Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. DESIGN: For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. METHODS:Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). RESULTS: At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. CONCLUSIONS: A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. PRACTITIONER POINTS: A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
RCT Entities:
OBJECTIVES: Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressedpatients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. DESIGN: For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. METHODS:Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). RESULTS: At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. CONCLUSIONS: A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysispatients. PRACTITIONER POINTS: A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
Authors: Jieling Chen; Lingling Liu; Jing Chen; Marques S N Ng; Vivian W Q Lou; Bibo Wu; Weijie Jiang; Yanqing Jie; Jingfen Zhu; Yaping He Journal: Qual Life Res Date: 2021-05-11 Impact factor: 4.147
Authors: Serena Barello; Gloria Anderson; Marta Acampora; Caterina Bosio; Elena Guida; Vincenzo Irace; Carlo Maria Guastoni; Barbara Bertani; Guendalina Graffigna Journal: Int Urol Nephrol Date: 2022-10-01 Impact factor: 2.266
Authors: Patrizia Natale; Suetonia C Palmer; Marinella Ruospo; Valeria M Saglimbene; Kannaiyan S Rabindranath; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2019-12-02