Abstract
BackgroundDepression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL). Although cognitive behavioural therapy (CBT) has been shown to improve depressive symptoms and QoL in other chronic illness, there is uncertainty in terms of the effectiveness of CBT in HD patients with depression or depressive symptoms.MethodsAll randomised controlled trials relevant to the topic were retrieved from the following databases: CINHAL, MEDLINE, PubMed, PsycINFO and CENTRAL. The grey literature, specific journals, reference lists of included studies and trials registers website were also searched. Data was extracted or calculated from included studies that had measured depression and quality of life using valid and reliable tools –this included mean differences or standardised mean differences and 95% confidence intervals. The Cochrane risk of bias tool was used to identify the methodological quality of the included studies.ResultsSix RCTs were included with varying methodological quality. Meta-analysis was undertaken for 3 studies that employed the CBT versus usual care. All studies showed that the depressive symptoms significantly improved after the CBT. Furthermore, CBT was more effective than usual care (MD = − 5.28, 95%CI − 7.9 to − 2.65, P = 0.37) and counselling (MD = − 2.39, 95%CI − 3.49 to − 1.29), while less effective than sertraline (MD = 2.2, 95%CI 0.43 to 3.97) in alleviating depressive symptoms. Additionally, the CBT seems to have a beneficial effect in improving QoL when compared with usual care, while no significant difference was found in QoL score when compared CBT with sertraline.ConclusionsCBT may improve depressive symptoms and QoL in HD patients with comorbid depressive symptoms. However, more rigorous studies are needed in this field due to the small quantity and varied methodological quality in the identified studies.
Highlights
Depression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL)
Studies were included if participants who had depression or depressive symptoms were assessed by investigators using structured clinic interview (DSM) or validated depression scales
Characteristics of included studies A total of six randomised controlled trials (RCTs) and 479 participants were included in the current review (248 in cognitive behavioural therapy (CBT) groups, 231 in control groups)
Summary
Depression is highly prevalent among Haemodialysis (HD) patients and is known to results in a series of adverse outcomes and poor quality of life (QoL). The depression symptoms of HD patients are associated with a series of adverse outcomes, for instance, lower treatment compliance [7, 8], malnutrition, increased morbidity [9], decreased quality of life, higher rates of hospitalisation and mortality among HD patients [10,11,12]. Depression issues are often under recognized and untreated [13]
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