Abstract
BackgroundEnd 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.MethodsThis 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.ResultsPrimary 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.ConclusionsFindings 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.Trial registrationACTRN12617000249358; 17/02/2017.
Highlights
End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing
Depression can be common in people undergoing dialysis (25% show depressive symptoms when assessed by clinical interview, 40% when assessed by self-report measures) [6] with depressive symptoms considered a risk factor for poor outcome [7]
This study aimed to determine whether the AIMhi Stay Strong App improves mental health and wellbeing for Indigenous people receiving haemodialysis, relative to delayed-treatment control groups at 3 months, and whether benefits are maintained at 6 months postrecruitment
Summary
End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. End-stage kidney disease (ESKD) is the most severe form of chronic kidney disease (CKD) and requires a transplant or dialysis for survival. In Australia, rates of ESKD are higher among the elderly, Indigenous Australians and people living in remote and socioeconomically disadvantaged areas [1,2,3]. Australia’s Northern Territory is a large geographical area consisting of a relatively small population of non-Indigenous people living mostly in urban centres along with smaller Indigenous groups living mostly in remote settings distant from centralised services [4]. For Indigenous patients in the NT, access to haemodialysis usually requires relocation to urban centres adding to the already high emotional burden associated with ESKD. Depression can be common in people undergoing dialysis (25% show depressive symptoms when assessed by clinical interview, 40% when assessed by self-report measures) [6] with depressive symptoms considered a risk factor for poor outcome [7]
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