Long-term Effects of a Brief Mindfulness Intervention Versus a Health Enhancement Program for Treating Depression and Anxiety in Patients Undergoing Hemodialysis: A Randomized Controlled Trial

Christina Rigas, Haley Park, Marouane Nassim, Chien-Lin Su, Kyle Greenway, Mark Lipman, Clare McVeigh, Marta Novak, Emilie Trinh, Ahsan Alam, Rita S Suri, Istvan Mucsi, Susana G Torres-Platas, Helen Noble, Harmehr Sekhon, Soham Rej, Michael Lifshitz, Christina Rigas, Haley Park, Marouane Nassim, Chien-Lin Su, Kyle Greenway, Mark Lipman, Clare McVeigh, Marta Novak, Emilie Trinh, Ahsan Alam, Rita S Suri, Istvan Mucsi, Susana G Torres-Platas, Helen Noble, Harmehr Sekhon, Soham Rej, Michael Lifshitz

Abstract

Background: Depression and anxiety affect approximately 50% of patients with kidney failure receiving hemodialysis and are associated with decreased quality of life and increased risk of hospitalization and mortality. A Brief Mindfulness Intervention (BMI) may be promising in treating depressive and anxiety symptoms in this population, but the long-term sustainability of the intervention's effects is unknown.

Objective: We previously conducted a randomized controlled trial (RCT; n = 55) comparing an 8-week BMI with an active control (Health Enhancement Program [HEP]) for patients receiving dialysis, with depression and/or anxiety. Here, we examine the 6-month follow-up data to determine the long-term sustainability of BMI versus HEP in reducing (1) depressive symptoms, (2) anxiety symptoms, and (3) the efficacy of BMI versus HEP in reducing the likelihood of hospitalization.

Design: In this study, we analyzed 6-month follow-up data from an 8-week assessor-blinded parallel RCT, which evaluated the efficacy of a BMI against an active control, HEP, in patients receiving hemodialysis with symptoms of depression and/or anxiety.

Setting: The study took place at hemodialysis centers in 4 tertiary-care hospitals in Montreal, Canada.

Participants: Participants included adults aged ≥18 years who were receiving in-center hemodialysis 3 times per week and had symptoms of depression and/or anxiety as indicated by a score ≥6 on the Patient Health Questionnaire-9 (PHQ-9) and/or the General Anxiety Disorder-7 (GAD-7).

Methods: Participants were randomized to the treatment arm (BMI) or the active control arm (HEP) and completed assessments at baseline, 8 weeks, and 6-month follow-up. Depression was assessed using the PHQ-9, and anxiety was assessed by the GAD-7. Hospitalization rates were assessed using medical chart information.

Results: We observed significant decrease in depression scores over 6 months in both BMI and HEP groups, with no significant difference between groups. Anxiety scores significantly decreased over 6 months, but only in the BMI group. Brief Mindfulness Intervention and Health Enhancement Program were comparable in terms of hospitalization rates.

Limitations: The limitations of our study include the modest sample size and lack of a third arm such as a waitlist control.

Conclusions: Our results suggest that the beneficial effects of BMI and HEP for improving mood disorder symptoms in patients receiving dialysis persist at 6-month follow-up. Both interventions showed sustained effects for depressive symptoms, but BMI may be more useful in this population given its efficacy in reducing anxiety symptoms as well.

Trial registration: Prior to recruitment, the trial had been registered (ClinicalTrials.gov Identifier: NCT03406845).

Keywords: anxiety; depression; dialysis; hospitalization; mindfulness.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
Participant flowchart. Note. BMI = Brief Mindfulness Intervention; HEP = Health Enhancement Program.
Figure 2.
Figure 2.
Change in PHQ-9 depression scores over time BMI versus HEP. Note. PHQ-9 = Patient Health Questionnaire–9; BMI = Brief Mindfulness Intervention; HEP = Health Enhancement Program; CI = confidence interval. *P < .05.
Figure 3.
Figure 3.
Change in GAD-7 anxiety scores over time BMI versus HEP. Note. GAD-7 = General Anxiety Disorder–7; BMI = Brief Mindfulness Intervention; HEP = Health Enhancement Program; CI = confidence interval. *P < .05.
Figure 4.
Figure 4.
Likelihood of hospitalization BMI versus HEP. Note. BMI = Brief Mindfulness Intervention; HEP = Health Enhancement Program.

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