Abstract
Depressive symptoms are common psychiatric comorbidities among individuals receiving long-term hemodialysis. The aim of this two-arm parallel design study is to assess the effects of bright light therapy (BLT) on depressive symptoms among middle-aged and older adults receiving long-term hemodialysis. Study participants are recruited using convenient sampling from four dialysis clinics in eastern Taiwan. The eligible participants are block-randomized to either the BLT group (n = 30), with 30 min sessions of BLT five times a week for six weeks at their own home, or to the routine care control group (n = 30). The Beck Depression Inventory-II (BDI-II) scores and the salivary cortisol levels are obtained from the participants at three time points: baseline (T0), week 3 (T1), and week 6 (T2). The results, from the generalized estimating equations, indicate that the decline in the BDI-II scores over time is significant in the BLT group at T1 (β = −7.57, p < 0.001) and at T2 (β = −6.20, p = 0.002) compared to the control group. The decrease in salivary cortisol levels at each visit is also significant in the BLT group at T1 (β = −7.37, p = 0.017) and at T2 (β = −12.22, p = 0.005) compared to the control group. Our findings support the hypothesis that a six-week program of BLT is able to alleviate depressive symptoms in middle-aged and older patients who receive long-term hemodialysis.
Highlights
End-stage renal disease (ESRD), which refers to the permanent and irreversible damage to the kidneys, is the fifth stage in the progression of chronic kidney disease
Results from the generalized estimating equations (GEEs) showed that the interaction terms between group and time were significant for both the Beck Depression Inventory-Second Edition (BDI-II) scores and the salivary cortisol levels at T1 and T2
The decrease in the BDI-II scores over time was significantly greater in the bright light therapy (BLT) group compared to the control group at T1 (β = −7.57, p < 0.001) and T2 (β = −6.20, p = 0.002); the decrease in the salivary cortisol levels was significant in the BLT group at T1 (β = −7.37, p = 0.017) and T2 (β = −12.22, p = 0.005) compared to the control group (Table 3)
Summary
End-stage renal disease (ESRD), which refers to the permanent and irreversible damage to the kidneys, is the fifth stage in the progression of chronic kidney disease. Patients with ESRD must rely on renal replacement therapy, such as kidney transplantation or dialysis, for survival. It is estimated that over 2.6 million people receive renal replacement therapy worldwide and that the number is projected to double to 5.4 million by 2030 [1]. According to the 2017 United States Renal Data System’s annual report comparing data across 73 countries and regions, Taiwan showed both the highest prevalence of treated ESRD, at 3317 individuals per million general population, and the highest incidence of treated. ESRD, at 476 individuals per million general population [2]. The direct health care costs of hemodialysis are covered by the Taiwan’s National Health Insurance system, which were estimated to be NTD 70,000 (USD 1 = NTD 30 in January 2020) per patient-month, there are additional out-of-pocket. Public Health 2020, 17, 7763; doi:10.3390/ijerph17217763 www.mdpi.com/journal/ijerph
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