Cognitive Behavioral Treatment of Depression in ESRD Patients on Dialysis

Depression is second in frequency only to hypertension as a comorbid condition for End Stage
Renal Disease (ESRD) patients. The presence of depression has been linked to lower quality of
life, more medical comorbidities and shorter lifespan. This project represents the first
known attempt at a standardized intervention for depression in ethnically diverse ESRD
patients. The study will be conducted at the Parkside Center for Dialysis. Patients will be
randomly selected for screening until 80 subjects meet entry criteria and agree to be
randomized. Once subjects are screened and enrolled in the study they are randomly assigned
to either a treatment or wait-list control condition. After 3 months, the intervention will
be completed and both groups will be reassessed. After an additional 3 months, both groups
will have received the intervention and pre and post measures for both groups will be
available as well as 3 month follow-up for the 1st intervention group.

The following measures will be collected: to obtain a full DSM-IV diagnosis the SCID I and
SCID II will be utilized. The BDI will provide a self-report measure of depression. The
Hospital Anxiety and Depression Scale (HADS), a measure designed specifically for medically
ill patients, will also be administered. Additionally, the Young Schema Questionnaire, a
measure which seeks to identify maladaptive (both depressive and anxious) cognitive styles,
will be administered. A quality of life measure designed specifically for dialysis patients
(KDQOL-SF) will also be given as a means of measuring patient's overall coping and
functioning. To better understand the patient's perceptions of their health and illness the
Illness Effects Questionnaire will be administered. A demographic information sheet will be
completed by the subject in which personal, ethnic, and illness information is collected.
Detailed information about the subject's mental health history and treatment as well as
current medications will be gathered. Data from routine dialysis laboratories (hemoglobin,
creatinine, albumin, Kt/V) will be extracted from the chart.

The intervention will take place in individual format while the subjects are being dialyzed.
The intervention will be 10 sixty minute -long weekly sessions spread over not more than 3
months. It will include both cognitive and behavioral skills focused on alleviating
depressive affect and identifying maladaptive patterns of thought and behavior. This study
would lay the groundwork for future clinical research by helping to develop a culturally
competent clinical intervention and demonstrate the feasibility and effectiveness of adapting
psychosocial intervention for a medically complex culturally diverse population.