Impact of Psychosocial Interventions on Depression in Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Prasad M.

Abstract The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool is a systematic approach used to assess the certainty of evidence and strength of recommendations in healthcare guidelines. It emphasizes the importance of considering the strengths and weaknesses of the evidence, as well as values, preferences, and practical considerations when making healthcare decisions. The GRADE methodology aims to enhance transparency, consistency, and rigor in evaluating evidence and informing clinical decision-making. GRADE uses a structured approach to assign a rating of high, moderate, low, or very low certainty to the evidence. Factors affecting certainty—study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias—are considered in rating the certainty or confidence in evidence. The guideline recommendations emanating from applying the GRADE approach are strong or conditional/weak. The strength of a recommendation depends on the balance between the desirable and undesirable effects, the quality of evidence, values and preferences of stakeholders, and resource considerations. The Evidence to Decision (EtD) framework provides a structured approach to making recommendations based on the evidence assessment. This article describes the key components of the GRADE tool, including the factors considered in assessing evidence quality, the process for rating certainty, and the implications for developing recommendations.

Pearce C.J., Hall N., Hudson J.L., Farrington K., Tucker M.J., Wellsted D., Jones J., Sharma S., Norton S., Ormandy P., Palmer N., Quinnell A., Fitzgerald L., Griffiths S., Chilcot J.

Shorey S., Ng E.D., Wong C.H.

Adolescence is a formative and turbulent phase where physiological, psychosocial, and cognitive changes leave adolescents vulnerable to psychological disorders. Given the lack of reviews that consolidate and compare worldwide prevalence of depression among adolescents, this review aims to examine the global prevalence of major depressive disorders, dysthymia, and elevated depressive symptoms among adolescents.A systematic review and meta-analysis was conducted. Six databases were searched for studies published from 2001 to December 2020. Seventy-two studies were included. Subgroup analysis were performed for year of publication, geographical region, gender, and assessment tools used.The global point prevalence rate of elevated self-reported depressive symptoms from 2001 to 2020 was 34% (95% CI: 0.30-0.38). Point prevalence for major depressive disorder (MDD) and dysthymia was 8% (95% CI: 0.02-0.13) and 4% (95% CI: 0.01-0.07), respectively. The pooled one-year prevalence and lifetime prevalence for MDD were 8% (95% CI: 0.05-0.12) and 19% (95% CI: 0.12-0.26). Point prevalence of elevated depressive symptoms among adolescents increased from 24% (95% CI: 0.19-0.28) between 2001 and 2010 to 37% (95% CI: 0.32-0.42) between 2011 and 2020. The Middle East, Africa, and Asia have the highest prevalence of elevated depressive symptoms, and female adolescents were reported to have a higher prevalence of elevated depressive symptoms than male adolescents.Besides targeting those with existing clinical depression, research and policies should also focus on educational and supportive mitigation efforts to curb depressive symptoms among adolescents before escalation. The findings encourage future research to develop more gender-specific and culturally relevant intervention programmes.34% of adolescents globally, aged 10-19 years, are at risk of developing clinical depression, which exceeds the reported estimates of individuals aged 18 to 25 years. Practitioners are highly encouraged to prioritize depression screening and intervention implementation for individuals in this age group. Female adolescents and adolescents from Middle East, Africa, and Asia have the highest risk of developing depression. This urges practitioners and researchers to develop more gender-specific and culturally relevant intervention programmes.

Látos M., Lázár G., Ondrik Z., Szederkényi E., Hódi Z., Horváth Z., Csabai M.

There is an increasing body of evidence proving that transplanted patients’ perceptions of their disease and their emotional state may have an influence on their physical recovery, but there are relatively few psychological interventions specifically developed to support their healing process. The aim of our study was to explore the effectiveness of a positive psychology intervention programme on the pre- and postoperative psychological state of kidney transplant patients. Clinical trial registration number: NEP-PSZICH-001, 13.15.2014. A total of 40 kidney transplant patients were assessed using the Spielberger Anxiety Inventory, Beck’s Depression Inventory, Transplanted Organ Questionnaire, Brief Illness Questionnaire and the Posttraumatic Growth Inventory during a 1-year follow-up. Medical parameters were collected throughout the 1-year period after transplantation. Compared to the control group, patients in the intervention group had lower anxiety and depression, and higher Posttraumatic Growth scores, and they had shown more positive attitude toward the transplant and their illness. We consider it as our most outstanding result that the estimated glomerular filtration rate and serum creatinine levels were significantly better among patients receiving positive psychology intervention, both after 6 months and after one year following their kidney transplantation. The findings show that mental functioning and general well-being of kidney transplant patients improved after our positive psychology intervention programme, and these improvements were also associated with better kidney functions in the long run.

Dingwall K.M., Sweet M., Cass A., Hughes J.T., Kavanagh D., Howard K., Barzi F., Brown S., Sajiv C., Majoni S.W., Nagel T.

End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. ACTRN12617000249358 ; 17/02/2017.

Morais E.M., Moreira P.R., Winkelmann E.R.

Objective Evaluate the effect of watching comedy movies as a complementary practice during dialysis on levels of anxiety, depression, quality of life, stress, laboratory findings and intra-dialysis complications.Methods: A randomized clinical trial was conducted involving the practice of presenting comedy movies during dialysis. The primary outcome was depression. The secondary outcomes were anxiety, quality of life, stress, laboratory findings and intra-dialysis complications.ResultsTwenty-six patients were in the control group and 35 were in the experimental group. Significant intra-group differences [6.0 to 3.0 (p

Amir-Behghadami M., Janati A.

Dear editor, We read with great interest the review entitled ‘Paracetamol vs other analgesia in adult patients with minor musculoskeletal injuries: a systematic review’,1 published in the Emergency Medicine Journal . Although the authors have stated that they followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, there is a methodological issue regarding the study discussed in this letter, which …

Sterne J.A., Savović J., Page M.J., Elbers R.G., Blencowe N.S., Boutron I., Cates C.J., Cheng H., Corbett M.S., Eldridge S.M., Emberson J.R., Hernán M.A., Hopewell S., Hróbjartsson A., Junqueira D.R., et. al.

Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention. The most commonly used tool for randomised trials is the Cochrane risk-of-bias tool. We updated the tool to respond to developments in understanding how bias arises in randomised trials, and to address user feedback on and limitations of the original tool.

Mehrotra R., Cukor D., Unruh M., Rue T., Heagerty P., Cohen S.D., Dember L.M., Diaz-Linhart Y., Dubovsky A., Greene T., Grote N., Kutner N., Trivedi M.H., Quinn D.K., ver Halen N., et. al.

Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited.To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis.Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343).41 dialysis facilities in 3 U.S. metropolitan areas.Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2.Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2).The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks.The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, -12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 [CI, -3.54 to -0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group.No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed.An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT.Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.

Chilcot J., Almond M.K., Guirguis A., Friedli K., Day C., Davenport A., Wellsted D., Farrington K.

To validate the factor structure of two common self-report depression tools in a large sample of haemodialysis (HD) patients and to examine their demographic and clinical correlates, including urine output, history of depression and transplantation.Factor structures of the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9) were evaluated using confirmatory factor analysis (CFA). Data was utilised from the screening phase (n = 709) of a placebo-controlled feasibility randomised control trial (RCT) of sertraline in HD patients with mild to moderate Major Depressive Disorder. Alternative factor models including bi-factor models for the BDI-II and PHQ-9 were evaluated. Coefficient omega and omega-hierarchical were calculated.For both measures, bi-factor measurement models had the overall best fit to the data, with dominant general depression factors. Omega-hierarchical for the general BDI-II and PHQ-9 factors was 0.94 and 0.88 respectively. Both general factors had high reliability (coefficient omega = 0.97 and 0.94 respectively) and explained over 85% of the explained common variance within their respective models. BDI-II and PHQ-9 general depression factors were negatively associated with age and urine output and positively with a history of depression, antidepressant use within the last 3 months and a history of failed transplantation. In adjusted regression models, age, urine output and a history of depression remained significant.These data suggest that both the BDI-II and PHQ-9 are sufficiently unidimensional to warrant the use of a total score. Younger age, lower urine output and a history of depression appear consistent correlates of depression severity among HD patients.

Al saraireh F.A., Aloush S.M., Al Azzam M., Al Bashtawy M.

Chilcot J., Hudson J.L., Moss-Morris R., Carroll A., Game D., Simpson A., Hotopf M.

To validate the factor structure of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)- which is a composite measure of depression and anxiety using the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Scale (GAD-7), in a sample of haemodialysis patients.Screening data (n=182) used to select entry into a feasibility study of an online cognitive-behavioural therapy intervention for distress in dialysis patients were analysed here. Structural validity of the PHQ-ADS was evaluated using confirmatory factor analysis (CFA), assessing alternative models including a bi-factor model. In the bi-factor model all items from the PHQ-9 and GAD-7 (16-items in total) were loaded onto a general distress factor. Respective items of the PHQ-9 and GAD-7 were specified as subgroup factors. Omega-hierarchical was calculated to indicate the level of saturation of a multidimensional scale by a general factor. Construct validity was determined against the Brief Illness Perception Questionnaire.A bi-factor PHQ-ADS model had good fit to the data (chi-square=96.1, p=0.26, CFI=0.99; TLI=0.99; RMSEA=0.02). The general distress factor accounted for approximately 84% of the explained variance (omega-h=0.90). Distress scores were significantly higher in females compare with males. There was a significant association between distress and negative illness perceptions (r=0.58, p

Babamohamadi H., Sotodehasl N., Koenig H.G., Al Zaben F., Jahani C., Ghorbani R.

Patients with advanced renal failure often face considerable sociopsychological stress as a result of lifestyle changes due to the disease and its treatment. The aim of the present study is to examine the effect of the Holy Qur’an recitation on depressive symptoms in hemodialysis patients. In this clinical trial, 54 hemodialysis patients were randomized to either an experimental (n = 27) or a control (n = 27) group. Patients completed the Beck Depression Inventory-II (BDI-II) at baseline and at 1 month after the intervention. Participants in the experimental group listened to recitation of the Holy Qur’an, while those in the control group received no intervention. The mean BDI-II score at baseline was 33.6 (±6.7) for the experimental group and 29.3 (±9.0) for the control group; at the end of treatment, BDI-II scores in the experimental and control groups were 14.5 (±4.8) and 31.6 (±9.2), respectively. Results from the repeated-measures general linear model controlling for baseline differences indicated a significant treatment effect (F = 9.30, p = 0.004, Cohen’s d = 0.85). Holy Qur’an recitation has a significant effect on lowering depressive symptoms in hemodialysis patients. Holy Qur’an recitation is an easy-to-implement and cost-effective strategy that may be used to supplement the treatment of depression in this setting in Iran.

Carhart-Harris R.L., Bolstridge M., Rucker J., Day C.M., Erritzoe D., Kaelen M., Bloomfield M., Rickard J.A., Forbes B., Feilding A., Taylor D., Pilling S., Curran V.H., Nutt D.J.

Psilocybin is a serotonin receptor agonist that occurs naturally in some mushroom species. Recent studies have assessed the therapeutic potential of psilocybin for various conditions, including end-of-life anxiety, obsessive-compulsive disorder, and smoking and alcohol dependence, with promising preliminary results. Here, we aimed to investigate the feasibility, safety, and efficacy of psilocybin in patients with unipolar treatment-resistant depression.In this open-label feasibility trial, 12 patients (six men, six women) with moderate-to-severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 mg and 25 mg, 7 days apart) in a supportive setting. There was no control group. Psychological support was provided before, during, and after each session. The primary outcome measure for feasibility was patient-reported intensity of psilocybin's effects. Patients were monitored for adverse reactions during the dosing sessions and subsequent clinic and remote follow-up. Depressive symptoms were assessed with standard assessments from 1 week to 3 months after treatment, with the 16-item Quick Inventory of Depressive Symptoms (QIDS) serving as the primary efficacy outcome. This trial is registered with ISRCTN, number ISRCTN14426797.Psilocybin's acute psychedelic effects typically became detectable 30-60 min after dosing, peaked 2-3 h after dosing, and subsided to negligible levels at least 6 h after dosing. Mean self-rated intensity (on a 0-1 scale) was 0·51 (SD 0·36) for the low-dose session and 0·75 (SD 0·27) for the high-dose session. Psilocybin was well tolerated by all of the patients, and no serious or unexpected adverse events occurred. The adverse reactions we noted were transient anxiety during drug onset (all patients), transient confusion or thought disorder (nine patients), mild and transient nausea (four patients), and transient headache (four patients). Relative to baseline, depressive symptoms were markedly reduced 1 week (mean QIDS difference -11·8, 95% CI -9·15 to -14·35, p=0·002, Hedges' g=3·1) and 3 months (-9·2, 95% CI -5·69 to -12·71, p=0·003, Hedges' g=2) after high-dose treatment. Marked and sustained improvements in anxiety and anhedonia were also noted.This study provides preliminary support for the safety and efficacy of psilocybin for treatment-resistant depression and motivates further trials, with more rigorous designs, to better examine the therapeutic potential of this approach.Medical Research Council.

Bahmani B., Motamed Najjar M., Sayyah M., Shafi-Abadi A., Haddad Kashani H.

<p><strong>INTRODUCTION: </strong>Hopefulness is one of the most significant predictors of adaptation in hemodialysis patients, and plays a vital role in the recovery process. In contrast to hopefulness, depression is a frequent psychological reaction of the hemodialysis treatment with many negative consequences.  The current research was designed to examine the effect of cognitive-existential treatment on the level of hopefulness and depression in hemodialysis patients.</p><p><strong>MATERIALS &amp; METHODS:</strong> This quasi-experimental research included 22 female patients suffering from chronic kidney failure disease undergoing hemodialysis treatment for at least 3 months. The patients were randomly assigned into two groups of experimental and control conditions. The experimental group received a combination of treatment including some elements of "existentialism" philosophy and a "cognitive" approach designed for the Iranian population. The treatment protocol lasted for 12 sessions of 90 minutes twice per week prior to the entry of the patient to the dialysis session.  Miller’s hope scale and BDI-II-21 were employed to collect the data. Statistical analysis was performed on the data using analysis of covariance by SPSS: 16 software.</p><p><strong>RESULTS:</strong> The result of the analysis indicated that there was a significant improvement in hopefulness level and decrease in depression of the patients in the experiment condition (P&lt;0.01).</p><p><strong>CONCLUSION:</strong> The result of analysis showed that cognitive-existential treatment resulted in the increase of hopefulness and decrease level of depression in the hemodialysis patients suffering from chronic kidney failure.</p>