October 21, 2020
1 min read
Higher levels of psychological flexibility were associated lower prevalence and incidence of depression among patients who had chronic kidney disease and were treated with peritoneal dialysis, hemodialysis or no dialysis.
“In patients with kidney disease, daily self-care and dialysis-related symptoms can be painful experiences, and depression is common,” Hidekazu Iida, MD, MPH, of the department of clinical epidemiology at Fukushima Medical University and You Home Clinic, and colleagues wrote in Kidney Medicine.
Iida and colleagues used the acceptance and action questionnaire (AAQ-II) to measure psychological flexibility, which they wrote “is the ability to be open to personal experiences, such as unpleasant sensations, thoughts and feelings, without altering their frequency or contents” and hinges on “acceptance,” for a cross-sectional analysis of 433 patients (mean age, 66.7 years; women, 32%). They used the Center for Epidemiologic Studies Depression Scale to measure depression for a longitudinal analysis of 191 patients whose scores did not indicate depression at baseline. Depression was the main study outcome.
At baseline, 33.3% of patients experienced depression. Patients treated with dialysis had higher AAQ-II scores, reflecting lower levels of psychological flexibility than patients who were not treated with dialysis (adjusted mean difference: peritoneal dialysis, 2.26 points; 95% CI, 0.23-4.28 vs. hemodialysis 3.16 points; 95% CI, 1.39-4.94). The effect size on the total AAQ-II score was 0.28 for peritoneal dialysis and 0.40 for hemodialysis. In a longitudinal analysis that was reversed so higher AAQ-II scores indicated higher degrees of psychological flexibility, a five-point AAQ-II score increase was associated with a lower risk for depression (adjusted RR = 0.72; 95% CI, 0.61-0.85).
Regarding the clinical implications of their findings, researchers wrote that psychological flexibility is “a modifiable factor” that can be targeted therapeutically and could predict depression if not present at baseline.