Brief Mindfulness Intervention vs. Health Enhancement Program for Patients Undergoing Dialysis: A Randomized Controlled Trial

Marouane Nassim, Haley Park, Elena Dikaios, Angela Potes, Sasha Elbaz, Clare Mc Veigh, Mark Lipman, Marta Novak, Emilie Trinh, Ahsan Alam, Rita S Suri, Zoe Thomas, Susana Torres-Platas, Akshya Vasudev, Neeti Sasi, Maryse Gautier, Istvan Mucsi, Helen Noble, Soham Rej, Marouane Nassim, Haley Park, Elena Dikaios, Angela Potes, Sasha Elbaz, Clare Mc Veigh, Mark Lipman, Marta Novak, Emilie Trinh, Ahsan Alam, Rita S Suri, Zoe Thomas, Susana Torres-Platas, Akshya Vasudev, Neeti Sasi, Maryse Gautier, Istvan Mucsi, Helen Noble, Soham Rej

Abstract

Background: Between 20-50% of patients undergoing maintenance dialysis for end-stage kidney disease experience symptoms of depression and/or anxiety, associated with increased mortality, greater health care utilization, and decreased quality of life. It is unknown whether mindfulness-based interventions can improve depression and anxiety symptoms in patients receiving this treatment.

Methods: We conducted an 8-week multicenter randomized controlled trial comparing a brief mindfulness intervention (BMI) vs. an active control (Health Enhancement Program [HEP]) in 55 patients receiving dialysis with symptoms of depression and/or anxiety. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) depression scores, with a primary analysis in participants with baseline PHQ-9 ≥ 10, and a secondary analysis including all participants. The secondary outcome was change in Generalized Anxiety Disorder-7 (GAD-7) anxiety scores with corresponding primary and secondary analyses.

Results: Both BMI and HEP reduced depressive symptoms, with no difference between trial arms (PHQ-9 change = -7.0 vs. -6.1, p = 0.62). BMI was more effective than HEP in reducing anxiety (GAD-7 change = -8.7 vs. -1.4, p = 0.01). Secondary analyses revealed no differences between arms.

Conclusions: For patients undergoing dialysis, both BMI and HEP may be helpful interventions for depression symptoms, and BMI may be superior to HEP for anxiety symptoms. Mindfulness-based and other psychosocial interventions may be further evaluated in those undergoing dialysis as treatment options for symptoms of depression and anxiety.

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

Conflict of interest statement

The authors declare no conflict of interest. Soham Rej received an investigator-initiated grant from Satellite Healthcare to conduct this study and receives a salary award from the Fonds de Recherche Québec Santé. The remaining authors have no disclosures to declare.

Figures

Figure 1
Figure 1
Participant flow diagram.

References

    1. United States Renal Data System . 2019 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD, USA: 2019.
    1. Zalai D., Szeifert L., Novak M. Psychological Distress and Depression in Patients with Chronic Kidney Disease. Semin. Dial. 2012;25:428–438. doi: 10.1111/j.1525-139X.2012.01100.x.
    1. Cukor D., Coplan J., Brown C., Friedman S., Cromwell-Smith A., Peterson R.A., Kimmel P.L. Depression and Anxiety in Urban Hemodialysis Patients. Clin. J. Am. Soc. Nephrol. 2007;2:484–490. doi: 10.2215/CJN.00040107.
    1. Hackett M.L., Jardine M.J. We Need to Talk about Depression and Dialysis: But What Questions Should We Ask, and Does Anyone Know the Answers? Clin. J. Am. Soc. Nephrol. 2017;12:222–224. doi: 10.2215/CJN.13031216.
    1. Halen N.V., Cukor D., Constantiner M., Kimmel P.L. Depression and Mortality in End-Stage Renal Disease. Curr. Psychiatry Rep. 2011;14:36–44. doi: 10.1007/s11920-011-0248-5.
    1. Loosman W.L., Rottier M.A., Honig A., Siegert C.E. Association of depressive and anxiety symptoms with adverse events in Dutch chronic kidney disease patients: A prospective cohort study. BMC Nephrol. 2015;16:1–8. doi: 10.1186/s12882-015-0149-7.
    1. El-Majzoub S., Mucsi I., Li M., Moussaoui G., Lipman M.L., Looper K.J., Novak M., Rej S. Psychosocial Distress and Health Service Utilization in Patients Undergoing Hemodialysis: A Prospective Study. J. Psychosom. Res. 2019;60:385–392. doi: 10.1016/j.psym.2018.10.001.
    1. Drayer R.A., Piraino B., Reynolds C.F., Houck P.R., Mazumdar S., Bernardini J., Shear M.K., Rollman B.L. Characteristics of depression in hemodialysis patients: Symptoms, quality of life and mortality risk. Gen. Hosp. Psychiatry. 2006;28:306–312. doi: 10.1016/j.genhosppsych.2006.03.008.
    1. Kimmel P.L., Peterson R.A. Depression in Patients with End-Stage Renal Disease Treated with Dialysis: Has the Time to Treat Arrived? Clin. J. Am. Soc. Nephrol. 2006;1:349–352. doi: 10.2215/CJN.00890306.
    1. Feroze U., Martin D., Reina-Patton A., Kalantar-Zadeh K., Kopple J.D. Mental health, depression, and anxiety in patients on maintenance dialysis. Iran. J. Kidney Dis. 2010;4:173–180.
    1. Watnick S., Kirwin P., Mahnensmith R., Concato J. The prevalence and treatment of depression among patients starting dialysis. Am. J. Kidney Dis. 2003;41:105–110. doi: 10.1053/ajkd.2003.50029.
    1. Palmer S.C., Natale P., Ruospo M., Saglimbene V.M., Rabindranath K.S., Craig J., Strippoli G.F.M. Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis. Cochrane Database Syst. Rev. 2016:CD004541. doi: 10.1002/14651858.CD004541.pub3.
    1. Hedayati S.S., Gregg L.P., Carmody T., Jain N., Toups M., Rush A.J., Toto R.D., Trivedi M.H. Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence: The CAST Randomized Clinical Trial. JAMA. 2017;318:1876–1890. doi: 10.1001/jama.2017.17131.
    1. Manley H.J., Garvin C.G., Drayer D.K., Reid G.M., Bender W.L., Neufeld T.K., Hebbar S., Muther R.S. Medication prescribing patterns in ambulatory haemodialysis patients: Comparisons of USRDS to a large not-for-profit dialysis provider. Nephrol. Dial. Transplant. 2004;19:1842–1848. doi: 10.1093/ndt/gfh280.
    1. Chiesa A., Calati R., Serretti A. Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin. Psychol. Rev. 2011;31:449–464. doi: 10.1016/j.cpr.2010.11.003.
    1. Keng S.-L., Smoski M.J., Robins C.J. Effects of mindfulness on psychological health: A review of empirical studies. Clin. Psychol. Rev. 2011;31:1041–1056. doi: 10.1016/j.cpr.2011.04.006.
    1. Zimmermann F.F., Burrell B., Jordan J. The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: A systematic review. Complement. Ther. Clin. Pract. 2018;30:68–78. doi: 10.1016/j.ctcp.2017.12.014.
    1. Compen F., Bisseling E., Schellekens M., Donders R., Carlson L., Van Der Lee M., Speckens A. Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial. J. Clin. Oncol. 2018;36:2413–2421. doi: 10.1200/JCO.2017.76.5669.
    1. Ford C.G., Vowles K., Smith B.W., Kinney A.Y. Mindfulness and Meditative Movement Interventions for Men Living with Cancer: A Meta-analysis. Ann. Behav. Med. 2020;54:360–373. doi: 10.1093/abm/kaz053.
    1. Thomas Z., Novak M., Platas S.G.T., Gautier M., Holgin A.P., Fox R., Segal M., Looper K.J., Lipman M., Selchen S., et al. Brief Mindfulness Meditation for Depression and Anxiety Symptoms in Patients Undergoing Hemodialysis a Pilot Feasibility Study. Clin. J. Am. Soc. Nephrol. 2017;12:2008–2015. doi: 10.2215/CJN.03900417.
    1. Nejad M.M., Shahgholian N., Samouei R. The effect of mindfulness program on general health of patients undergoing hemodialysis. J. Educ. Health Promot. 2018;7:74. doi: 10.4103/jehp.jehp_132_17.
    1. Gross C.R., Reilly-Spong M., Park T., Zhao R., Gurvich O.V., Ibrahim H.N. Telephone-adapted Mindfulness-based Stress Reduction (tMBSR) for patients awaiting kidney transplantation. Contemp. Clin. Trials. 2017;57:37–43. doi: 10.1016/j.cct.2017.03.014.
    1. Haghshenas M., Assarian F., Omidi A., Razaghof M., Rahimi H. Efficacy of Mindfulness-based Stress Reduction in Hemodialysis Patients with Anxiety and Depression: A randomized, double-blind, parallel-group trial. Electron. Physician. 2019;11:7370–7377. doi: 10.19082/7370.
    1. Bennett P.N., Ngo T., Kalife C., Schiller B. Improving wellbeing in patients undergoing dialysis: Can meditation help? Semin. Dial. 2017;31:59–64. doi: 10.1111/sdi.12656.
    1. Sohn B.K., Oh Y.K., Choi J.-S., Song J., Lim A., Lee J.P., An J.N., Choi H.-J., Hwang J.Y., Jung H.-Y., et al. Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients. Kidney Res. Clin. Pract. 2018;37:77–84. doi: 10.23876/j.krcp.2018.37.1.77.
    1. Hernandez R., Burrows B., Wilund K., Cohn M., Xu S., Moskowitz J.T. Feasibility of an Internet-based positive psychological intervention for hemodialysis patients with symptoms of depression. Soc. Work. Health Care. 2018;57:1–16. doi: 10.1080/00981389.2018.1523268.
    1. Kroenke K., Spitzer R.L., Williams J.B.W. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Spitzer R.L., Kroenke K., Williams J.B. Generalized Anxiety Disorder 7-item (GAD-7) scale. Arch. Intern. Med. 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Borson S., Scanlan J.M., Chen P., Ganguli M. The Mini-Cog as a Screen for Dementia: Validation in a Population-Based Sample. J. Am. Geriatr. Soc. 2003;51:1451–1454. doi: 10.1046/j.1532-5415.2003.51465.x.
    1. Levis B., Benedetti A., Thombs B.D. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ. 2019;365:l1476. doi: 10.1136/bmj.l1476.
    1. Chartier-Otis M., Perreault M., Bélanger C. Determinants of Barriers to Treatment for Anxiety Disorders. Psychiatr. Q. 2010;81:127–138. doi: 10.1007/s11126-010-9123-5.
    1. Pascoe M.C., Thompson D., Castle D.J., McEvedy S.M., Ski C.F. Psychosocial Interventions for Depressive and Anxiety Symptoms in Individuals with Chronic Kidney Disease: Systematic Review and Meta-Analysis. Front. Psychol. 2017;8:992. doi: 10.3389/fpsyg.2017.00992.
    1. Birkett M.A., Day S.J. Internal pilot studies for estimating sample size. Stat. Med. 1994;13:2455–2463. doi: 10.1002/sim.4780132309.
    1. Segal Z.V., Teasdale D. Mindfulness-Based Cognitive Therapy for Depression. Guildford Publications; New York, NY, USA: 2018.
    1. Maccoon D.G., Imel Z., Rosenkranz M.A., Sheftel J.G., Weng H.Y., Sullivan J.C., Bonus K.A., Stoney C.M., Salomons T.V., Davidson R.J., et al. The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR) Behav. Res. Ther. 2012;50:3–12. doi: 10.1016/j.brat.2011.10.011.
    1. Rosenkranz M.A., Davidson R.J., MacCoon D.G., Sheridan J.F., Kalin N.H., Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behav. Immun. 2013;27:174–184. doi: 10.1016/j.bbi.2012.10.013.
    1. Cohen J. Statistical Power for the Social Sciences. Laurence Erlbaum Associates; Hillsdale, NJ, USA: 1988.
    1. King N., Horrocks C., Brooks J. Interviews in Qualitative Research. SAGE Publications Limited; Thousand Oaks, CA, USA: 2018.
    1. Braun V., Clarke V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006;3:77–101. doi: 10.1191/1478088706qp063oa.
    1. Cukor D., Halen N.V., Asher D.R., Coplan J.D., Weedon J., Wyka K.E., Saggi S., Kimmel P.L. Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis. J. Am. Soc. Nephrol. 2013;25:196–206. doi: 10.1681/ASN.2012111134.
    1. Al Saraireh F.A., Aloush S.M., Al Azzam M., Al Bashtawy M. The Effectiveness of Cognitive Behavioral Therapy versus Psychoeducation in the Management of Depression among Patients Undergoing Haemodialysis. Issues Ment. Health Nurs. 2018;39:514–518. doi: 10.1080/01612840.2017.1406022.
    1. Valsaraj B.P., Bhat S.M., Latha K. Cognitive Behaviour Therapy for Anxiety and Depression among People Undergoing Haemodialysis: A Randomized Control Trial. J. Clin. Diagn. Res. 2016;10:VC06–VC10. doi: 10.7860/JCDR/2016/18959.8383.
    1. Cukor D., Coplan J., Brown C., Friedman S., Newville H., Safier M., Spielman L.A., Peterson R.A., Kimmel P.L. Anxiety Disorders in Adults Treated by Hemodialysis: A Single-Center Study. Am. J. Kidney Dis. 2008;52:128–136. doi: 10.1053/j.ajkd.2008.02.300.
    1. Mrazek A.J., Mrazek M.D., Cherolini C.M., Cloughesy J.N., Cynman D.J., Gougis L.J., Landry A.P., Reese J.V., Schooler J.W. The future of mindfulness training is digital, and the future is now. Curr. Opin. Psychol. 2019;28:81–86. doi: 10.1016/j.copsyc.2018.11.012.

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