Cognitive Behavioral Treatment of Depression in ESRD PAtients on Dialysis

本申请的目的是为丹尼尔Cukor，博士。过渡到一个独立的调查员， 心理社会肾病学领域。血液透析患者的抑郁与低血糖有关。 生活质量下降，对饮食限制的依从性差，死亡率总体上升。这项建议 Cukor博士是一位训练有素的临床健康心理学家，他将帮助Cukor博士测试认知行为疗法（CBT）。 专门为种族多样化的ESRD人群设计的干预措施， 抑郁情绪水平，并改善他们对血液透析健康生活方式的依从性。这是第一 尝试用受控的心理社会干预治疗终末期肾病患者的抑郁症。下 Jeremy Coplan，MD，Paul Kimmel，MD和Rolf Peterson，Ph.D.的指导，一次说教式的经历 已开发，以帮助Cukor博士进一步提高他在肾脏病学，心理学理论和 干预，以及研究方法。实际的干预是基于传统的CBT治疗 根据Cukor博士先前的临床经验，对ESRD人群进行了改良。 总的来说，这项研究提供了一个模型来测试这种干预对血液透析患者的疗效， 等待列表控件。80例受试者将随机分配至干预首选条件或等待列表 然后他们将接受10次会议的干预。心理、生物和医学信息将 在干预前后以及随访时收集，以提供受试者情绪的数据， 生活质量、行为依从性、精神病理学和疾病的一般影响。 该项目将为整个社区的健康做出贡献，因为它可以证明 针对不同种族透析患者的抑郁症和依从性的干预措施 人口这可能支持抑郁症和ESRD之间的关系是 双向的，这意味着有效的心理社会干预不仅会影响抑郁情绪， 依从性、生活质量和疾病感知，以及实验室透析值，甚至可能 整体健康。如果它被证明是有益的，这种有针对性的短暂干预可以被纳入 所有抑郁透析患者的标准治疗

The purpose of this application is for Daniel Cukor, Ph.D. to transition to an independent investigator in the field of psychosocial nephrology. Depression in hemodialysis patients has been associated with lower quality of life, poor compliance to dietary restrictions, and an overall increase in mortality. This proposal would help Dr. Cukor, a trained Clinical Health Psychologist, test a Cognitive Behavioral Therapy (CBT) Intervention that has been specifically designed for an ethnically diverse ESRD population to reduce their levels of depressive affect and improve their compliance with a hemodialysis-healthy lifestyle. This is the first attempt at treating depression in ESRD patients with a controlled psychosocial intervention. Under the mentorship of Jeremy Coplan, MD, Paul Kimmel, MD, and Rolf Peterson, Ph.D., a didactic experience has been devloped to help Dr. Cukor further his skills in the disciplines of nephrology, psychological theory and intervention, as well as research methodology. The actual intervention is based on traditional CBT treatment for depression with modifications for an ESRD population based on Dr. Cukor's previous clinical experience. Overall, this study provides a model to test the efficacy of this intervention on hemodialysis patients versus wait-list controls. Eighty subjects will be randomized to either the intervention first condition or the wait list and then they will receive the 10 session intervention. Psychological, Biological, and Medical information will be gathered before and after the intervention as well as at follow-up to provide data on the subjects' mood, quality of life, behavioral compliance, psychopathology and the general effects of their illness. This project stands to contribute to the health of the community at large, as it could demonstrate the efficacy of an intervention that is designed to target depression and compliance in an ethnically diverse dialysis population. This could lend support to the belief that the relationship between depression and ESRD is bidirectional, meaning that an effective psychosocial intervention will not only impact depressive affect, compliance, quality of life, and illness perceptions, but also laboratory dialysis values and even possibly overall health. If if it is proven to be benficial, this targeted and brief intervention could be incorporated into standard of care for all depressed dialysis patients.