Cognitive–behavioral group therapy is an effective treatment for major depression in hemodialysis patients

Duarte, Priscila Silveira; Miyazaki, Maria Cristina de Oliveira Santos; Blay, Sérgio Luís; Sesso, Ricardo

doi:10.1038/ki.2009.156

Cited by 224 publications

(211 citation statements)

References 39 publications

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“…Some of these treatment strategies, such as antidepressant medications (37), changes in dialysis treatment schedules or alternative dialysis therapies (38), cognitive-behavioral therapy (CBT) (39), exercise programs (40), and stress reduction therapies (to include music or art) (41), have been reported to improve symptoms or reduce depressive episodes in patients with ESRD (40). Duarte et al showed that CBT was effective: HD patients receiving group therapy showed significant improvements in the treatment of depression compared with the control group, who did not receive CBT (39). Another nondrug study by Cukor et al supports using CBT treatment in HD patients, with a successful reduction in major depression disorder (42).…”

Section: Discussionmentioning

confidence: 99%

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Lacson

Bruce

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk.Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting .24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions ("down in the dumps" and "downhearted and blue"). A high depressive affect score corresponded with an average response of "some of the time" or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively.Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models.Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future studies are needed to investigate the effect of therapeutic interventions to address depressive affect in this high-risk population.

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Section: Discussionmentioning

confidence: 99%

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Lacson

Bruce

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…The KDQOL has been widely used in hemodialysis patients. 11,13,28,45,46 The summary composite score is reported.…”

Section: Ham-dmentioning

confidence: 99%

“…26 Our pilot uncontrolled study provided encouraging evidence that individual CBT is an efficacious, acceptable, and practical treatment option for hemodialysis-treated ESRD patients with depressive symptoms. 27 One recent randomized trial of group CBT was conducted in Brazil, 28 in which 85 depressed hemodialysis-treated ESRD patients were randomized to receive standard care or group CBT for 12 weeks. Both the intervention and control groups demonstrated significant improvement in depression scores measured by self-report and clinician-administered measures.…”

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confidence: 99%

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

Cukor¹,

Halen²,

Asher³

et al. 2014

Journal of the American Society of Nephrology

212

234

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Patients with ESRD have high rates of depression, which is associated with diminished quality of life and survival. We determined whether individual cognitive behavioral therapy (CBT) reduces depression in hemodialysis patients with elevated depressive affect in a randomized crossover trial. Of 65 participants enrolled from two dialysis centers in New York, 59 completed the study and were assigned to the treatment-first group (n=33) or the wait-list control group (n=26). In the intervention phase, CBT was administered chairside during dialysis treatments for 3 months; participants were assessed 3 and 6 months after randomization. Compared with the wait-list group, the treatment-first group achieved significantly larger reductions in Beck Depression Inventory II (self-reported, P=0.03) and Hamilton Depression Rating Scale (clinician-reported, P,0.001) scores after intervention. Mean scores for the treatment-first group did not change significantly at the 3-month follow-up. Among participants with depression diagnosed at baseline, 89% in the treatment-first group were not depressed at the end of treatment compared with 38% in the wait-list group (Fisher's exact test, P=0.01). Furthermore, the treatment-first group experienced greater improvements in quality of life, assessed with the Kidney Disease Quality of Life Short Form (P=0.04), and interdialytic weight gain (P=0.002) than the wait-list group, although no effect on compliance was evident at follow-up. In summary, CBT led to significant improvements in depression, quality of life, and prescription compliance in this trial, and studies should be undertaken to assess the long-term effects of CBT on morbidity and mortality in patients with ESRD.

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“…This may be, in part, secondary to lack of high-level evidence for the efficacy of different approaches for treatment of depression in patients undergoing maintenance dialysis. Although singlecenter randomized controlled trials have demonstrated the efficacy of cognitive behavioral therapy for the treatment of depressive symptoms in patients undergoing in-center hemodialysis, there are no such studies in patients undergoing PD (17,18). To date, two single-center, uncontrolled studies have reported improvement in depressive symptoms with antidepressant drug therapy; similar uncontrolled studies have been published regarding the efficacy of medications for patients undergoing in-center hemodialysis (19,20).…”

Section: Question 1amentioning

confidence: 88%

American Society of Nephrology Quiz and Questionnaire 2013

Mehrotra

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.

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Cognitive–behavioral group therapy is an effective treatment for major depression in hemodialysis patients

Cited by 224 publications

References 39 publications

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

American Society of Nephrology Quiz and Questionnaire 2013

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