What is the issue?
Depression is frequently experienced by people treated with dialysis. Dialysis patients consider treatments that help with depression to be a high priority. Despite that fact that psychosocial interventions have been shown to decrease depression in various chronic
What is the issue?
Depression is frequently experienced by people treated with dialysis. Dialysis patients consider treatments that help with depression to be a high priority. Despite that fact that psychosocial interventions have been shown to decrease depression in various chronic diseases, we are very uncertain about whether treatments prevent or treat depression for dialysis patients as studies are rare.
What did we do?
This evidence is current to June 2019. We searched the medical literature and identified 33 studies with 2056 participants treated by dialysis. Studies evaluated a range of possible treatments including acupressure, cognitive-behavioural therapy (CBT), counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice control compared to usual care or other psychosocial treatments. We also checked the quality of the information in the studies to learn how certain we could be about the results.
What did we find?
We are moderately certain that CBT, exercise, and relaxation techniques probably decrease symptoms of depression for patients treated with long-term dialysis. Counselling may slightly decrease depression symptoms, while we are uncertain whether acupressure, telephone support, or meditation make any difference. We found moderate certainty evidence that CBT provides higher quality of life for dialysis patients. Studies did not measure effects of psychosocial treatments on major depression, suicide risk, and whether therapies made any difference to anxiety, hospital admissions, or withdrawal from dialysis treated is uncertain. Adverse events from treatment is very uncertain.
Some study authors did not report the methods for their studies clearly, so we could not be certain whether patients truly had a random chance of being in each treatment group or whether the trial results were assessed by people knowing which treatments that patients actually received. For most outcomes, we identified very few studies, which decreased our confidence in the results.
CBT, exercise, and relaxation techniques probably decrease depressive symptoms for dialysis patients while CBT also improves life quality. Counselling may slightly reduce depression among those receiving dialysis. We are not certain whether interventions prevent or treat major depression, anxiety, suicide risk, or withdrawal from dialysis care before death or whether psychological and social treatments have adverse effects.
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-rel