Internet-based problem solving therapy improves depressive and dialysis related physical symptoms in hemodialysis patients under 65 years of age: A post-hoc secondary subgroup analysis of a cluster randomized controlled trial
General Hospital Psychiatry, vol. 98, pp. 165–171
Abstract
Patients on hemodialysis therapy often experience a high burden of mental and physical health symptoms. We developed a guided internet-based self-help problem-solving therapy (IPST) targeted on practical daily life issues. While we did not find an effect for all patients, we hypothesized that an internet intervention might be effective in younger patients below 65 years of age. In this post-hoc secondary subgroup analysis we divided our study population based on age to study the effect of our intervention on depressive- and dialysis-related symptoms. Chronic hemodialysis patients with a depression score on the Beck Depression Inventory (BDI-II) of ≥10, were randomized into a five modules guided IPST or a care-as-usual control group. The study population was stratified by age (< 65 and ≥ 65 years). The primary outcome was depressive symptoms (BDI-II). Secondary outcomes were anxiety (BAI), health-related quality of life (HRQoL) and dialysis related symptoms (DSI). Analyses were performed using linear mixed models. 122 out of 190 randomized patients completed post-intervention measurements. In 25 younger patients (age < 65), a significant effect was found in reduction of BDI-II (−30 %, p = 0.04) and DSI (presence of symptoms: −27 %, p = 0.001; level of distress: −25 %, p = 0.03). No effect was seen on BAI or HRQoL. In the older population ( n = 29), no effect of the intervention was found on any outcomes. An easy to implement guided IPST showed a clinically relevant decrease in depressive symptoms and dialysis related physical symptoms in hemodialysis patients aged below 65 years although results should be interpreted cautiously given the post-hoc design. Details omitted for double-anonymized reviewing. • Patients on dialysis often experience a high burden of mental and physical health symptoms. There is a scarcity in RCTs on psychotherapeutic treatment of depression and dialysis related symptoms. • Because of multiple barriers in implementation of psychotherapy, we developed a guided internet-based problem-solving therapy (PST). This cognitive behavioral therapy (CBT) method focuses on practical daily life issues for hemodialysis patients. • This study consists of an RCT testing this internet-based PST intervention in a subpopulation of hemodialysis patients aged below 65 years. • While we did not find an effect of this intervention in the whole group (previously published), in a subpopulation of dialysis patients aged below 65 years this study suggests a significantly and clinically relevant effect of guided internet-based PST with a decrease in both depressive and dialysis related symptoms. • This innovative, accessible, tailor-made guided internet-based intervention can be easily implemented in routine hemodialysis care for patients <65 years of age. Patients found the intervention clear and easy to use and the quality of feedback was rated as good or excellent.
Authors 17
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Debbie Zittema corresponding
Amsterdam Public Health · GGZ inGeest · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Research Program, Amsterdam, the Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands. Electronic address: d.zittema@amsterdamumc.nl
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Affiliation as printed
Department of Nephrology, OLVG, Amsterdam, the Netherlands
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Affiliation as printed
Department of Psychiatry, OLVG, Amsterdam, the Netherlands
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Amsterdam Public Health · GGZ inGeest · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Research Program, Amsterdam, the Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands
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Affiliation as printed
Department of Nephrology, OLVG, Amsterdam, the Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Nephrology, Haaglanden Medisch Centrum, The Hague, the Netherlands
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Affiliation as printed
Department of Nephrology, HagaZiekenhuis, The Hague, the Netherlands
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Affiliation as printed
Department of Nephrology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
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Sint Franciscus Gasthuis · Franciscus Vlietland
Affiliation as printed
Department of Nephrology, Franciscus Gasthuis & Vlietland Ziekenhuis, Rotterdam, the Netherlands
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Ellen Karen Hoogeveen Aachen
Leiden University · Leiden University Medical Center · Jeroen Bosch Ziekenhuis
Affiliation as printed
Department of Nephrology, Jeroen Bosch Ziekenhuis, s-Hertogenbosch, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
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Willem J.W. Bos Aachen
Leiden University · Leiden University Medical Center · St. Antonius Ziekenhuis
Affiliation as printed
Department of Internal Medicine, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands; Department of Internal Medicine, Leiden University Medical Centre, Leiden, the Netherlands
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Affiliation as printed
Department of Nephrology, Tergooi MC, Hilversum, the Netherlands
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Affiliation as printed
Department of Nephrology, Spaarne Gasthuis, Haarlem, the Netherlands
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Amsterdam Public Health · GGZ inGeest · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Research Program, Amsterdam, the Netherlands; GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
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Affiliation as printed
Department of Nephrology, OLVG, Amsterdam, the Netherlands
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OLVG · Amsterdam Public Health · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Research Program, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
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