Internet-based problem solving therapy improves depressive and dialysis related physical symptoms in hemodialysis...

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.

Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).