Psychological Intervention for Depression and Anxiety in Hemodialysis Patients: A Meta-Analysis

Abstract

Background: With the advancement of blood purification technology, there is increasing attention to the mental health of hemodialysis patients, particularly concerning depression. This study aims to determine the effect of psychological interventions on anxiety and depression in hemodialysis patients through a meta-analysis. 

Methods: A computerized search was conducted to identify randomized controlled trial (RCT) studies published in PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library databases from their inception to October 2023, focusing on the effects of psychological interventions on improving depression in hemodialysis patients. Data extraction, quality evaluation, and cross-checking were performed independently by two researchers. The methodological quality of the included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews and the meta-analysis was performed using RevMan 5.4 software (The Nordic Cochrane Centre, Copenhagen, Denmark). The effect of psychological interventions on anxiety and depression in hemodialysis patients was determined by combining effect sizes and I² statistics. 

Results: Fifteen studies were included, encompassing a total of 929 hemodialysis patients: 468 in the intervention group and 461 in the control group. The results indicated that psychological interventions could improve depressive moods [mean difference (MD) = –4.91, 95% confidence intervals (CI) (–6.56, –3.26), p < 0.001] and anxiety status [MD = –5.11, 95% CI (–6.97, –3.25), p < 0.001]. A subgroup analysis based on the intervention duration (more or less than 8 weeks) revealed that patients experienced significant improvements in depression and anxiety regardless of the intervention length. Additionally, subgroup analyses focusing on quality of life demonstrated that psychological interventions significantly improved the psychological aspects of patients' quality of life [MD = 7.31, 95% CI (1.06, 13.56), p = 0.001]. Sensitivity analysis, which excluded sources of heterogeneity, indicated that psychological interventions significantly enhanced both the psychological [odds ratios (OR) = 4.14, 95% CI (1.08, 7.20), p = 0.008] and physical [MD = 2.52, 95% CI (0.10, 4.95), p = 0.04] aspects of patients' quality of life. 

Conclusion: Psychological interventions can significantly alleviate depression and anxiety in hemodialysis patients and improve their quality of life. Psychotherapy holds promise as an effective method for improving depression in dialysis patients.