Impact of Psychosocial Interventions on Depression in Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

Abstract

Background: Depression is prevalent among individuals with chronic kidney disease (CKD) and those undergoing dialysis, with significant impacts on morbidity and mortality. This systematic review and meta-analysis was done to evaluate the efficacy of psychosocial interventions in managing depressive symptoms in patients with CKD.

Methods: This systematic review and meta-analysis adhered to PRISMA guidelines. A literature search was conducted across PubMed, Embase, Google Scholar, and Cochrane Library databases from January 2007 to July 2024. Randomized controlled trials (RCTs) investigating psychosocial interventions in CKD patients (Stage 4 or 5 or on hemodialysis) were included. The primary outcome was the change in depressive symptoms, measured by standardized clinical tools. Quality of life was a secondary outcome. Data extraction and bias assessment were conducted using ROB-2 and GRADEpro GDT tools.

Results: Twelve studies with a total of 792 participants (420 in the intervention group and 372 in the control group) were included. Cognitive-behavioral therapy (CBT) was the most common intervention. Psychosocial interventions significantly reduced depressive symptoms compared to routine care (mean difference [MD]: -4.22; 95% CI: -6.67, -1.76; P = 0.0008). High heterogeneity (I² = 89%) was noted. Sensitivity analysis confirmed the robustness of the results. The impact on quality of life was not statistically significant (MD: 0.94; 95% CI: -0.61, 2.49; P = 0.24).

Conclusions: Moderate-quality evidence suggests that psychosocial interventions effectively reduce depressive symptoms in CKD patients. While no significant improvement in quality of life was observed, these interventions provide an alternative to pharmacological treatments, potentially minimizing drug-related side effects.