Psychological Flexibility and Depression in Advanced CKD and Dialysis

Abstract

Rationale & Objective Depression is prevalent and highly associated with mortality among patients with chronic kidney disease (CKD). Psychological flexibility can be captured as acceptance in psychology, and its improvement by behavioral therapy is associated with reduced depression in some clinical settings. However, no study has been reported on patients with CKD. This study aimed to examine the association between psychological flexibility and depression in patients with CKD. Study Design Cohort study. Setting & Participants This multicenter study of 5 hospitals in Japan included patients with nondialysis stage 3-5 CKD or stage 5D CKD receiving hemodialysis or peritoneal dialysis. Predictor Psychological flexibility measured using the 7-item Acceptance and Action Questionnaire (AAQ-II). Outcomes The prevalence and incidence of depression after 1 year, which was defined by a score ≥ 16 points on the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Analytical Approach Gamma regression was used in the examination of correlates of the psychological flexibility value. Modified Poisson regression models were fit for the prevalence and incidence of depression. Results The cross-sectional and longitudinal analyses included 433 and 191 patients, respectively. Lower (ie, worse) psychological flexibility levels were associated with hemodialysis and peritoneal dialysis. Higher (ie, better) psychological flexibility levels were associated with lower prevalence of depression (per 5-point increase; adjusted prevalence ratio, 0.75; 95% CI, 0.70-0.80) and lower incidence of depression (per 5-point increase; adjusted risk ratio, 0.72; 95% CI, 0.61-0.85). Limitations Depression was assessed using the CES-D questionnaire. Cultural differences may exist in the interpretation of AAQ-II scores. Conclusions Better psychological flexibility was associated with lower prevalence and incidence of depression in patients with CKD. Further studies are warranted to determine the possible prevention and treatment of depression by the development of behavioral interventions to improve psychological flexibility.

A Systematic Review of the Evidence on Inflammation in Depressive Illness and Symptoms, in Chronic and End Stage Kidney Disease

“…Psychological flexibility and adjustment to the diagnosis and treatment are predictors of better outcomes, and might be the mechanism by which therapeutic efforts might be helpful 92 . Indeed, acceptance and commitment therapy encourages psychological flexibility and is being tested in many chronic conditions including cancer survivors, and may have a place in the care of dialysis patients living with uncertainty 93 .…”

Health-related hope and reduced distress associated with fluid and dietary restrictions in advanced chronic kidney disease and dialysis: a cohort study

“…The total score ranges from 0 to 60, and a total score of 16 or higher was considered depressed. 17,23 The questionnaire was administered at each facility, and patients were asked to complete it at home or during their nephrology visit. In the event that patients could not write due to visual impairment or physical disability, they were asked to verbally complete the form with the aid of a trained research assistant who did not inform patients of the hypothesis.…”

COVID-19 Vaccination Improved Psychological Distress (Anxiety and Depression Scores) in Chronic Kidney Disease Patients: A Prospective Study

“…Vaccination is one of the most effective ways to stop the spread of COVID-19 infection, but while safe vaccines have been developed, there has been a growing distrust of them in some sectors of the population [5]. Within this context, people living with chronic kidney disease may suffer confusion and psychological impact, as well as other psychological effects, as shown by previous research [6][7][8]. Moreover, high mortality rates in CKD patients have been recorded after SARS-CoV-2 infection, especially those patients with kidney transplants and on dialysis [9,10].…”