Cognitive Behavioral Treatment of Depression in ESRD PAtients on Dialysis

本申请的目的是为了让Daniel Cukor博士过渡到一名独立的 心理社会肾脏学领域。血液透析患者的抑郁与低血压有关 生活质量、对饮食限制的遵从性差，以及死亡率总体上升。这项建议 将帮助训练有素的临床健康心理学家Cukor博士测试认知行为疗法(CBT) 专门为不同种族的ESRD人群设计的干预措施，以减少他们的 抑郁程度会影响并改善他们对血液透析健康生活方式的依从性。这是第一次 试图通过受控的心理社会干预治疗终末期肾病患者的抑郁。在.之下 杰里米·科普兰医学博士、保罗·基梅尔医学博士和罗尔夫·彼得森博士的指导，一次教学经历 被开发来帮助Cukor博士在肾脏病学，心理学理论和 干预，以及研究方法。实际干预以传统的CBT治疗为基础 根据Cukor博士之前的临床经验，对ESRD人群进行修改，以治疗抑郁症。 总体而言，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效果与 等待列表中的控件。80名受试者将被随机分为干预第一状态或等待名单 然后他们将接受10个疗程的干预。心理、生物和医学信息将 在干预前后以及在随访时收集，以提供关于受试者情绪的数据， 生活质量、行为依从性、精神病理学和疾病的一般影响。 这一项目将有助于整个社区的健康，因为它可以证明其功效 旨在针对不同种族透析中的抑郁和依从性的干预 人口。这可能会支持这样一种观点，即抑郁症和终末期肾病之间的关系是 双向，这意味着有效的心理社会干预不仅会影响抑郁情绪， 遵从性、生活质量和疾病认知，但也包括实验室透析价值，甚至可能 整体健康状况。如果它被证明是有益的，这种有针对性的短暂干预可以纳入 为所有抑郁的透析患者提供标准护理。

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.