Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis

Abstract

Objective: To examine the effectiveness of psychoeducational interventions on depression, anxiety, and health-related quality of life (HRQOL) for people undergoing maintenance hemodialysis (MHD).

Methods: This review used systematic review and meta-analysis as the research design. Nine databases, including PubMed, Web of Science, Embase, CINAHL Complete, Cochrane Library, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database, were searched from the inception to the 8th of July 2023. Two reviewers independently identified randomized controlled trials (RCT) examining the effects of psychoeducational interventions on MHD patients.

Results: Fourteen studies involving 1134 MHD patients were included in this review. The results of meta-analyses showed that psychoeducational intervention had significant short-term (< 1 m) (SMD: -0.87, 95% CI: -1.54 to -0.20, p = 0.01, I² = 91%; 481 participants), and medium-term (1-3 m) (SMD: -0.29, 95% CI: -0.50 to -0.08, p = 0.01, I² = 49%; 358 participants) on anxiety in MHD patients, but the effects could not be sustained at longer follow-ups. Psychoeducational interventions can also have short-term (< 1 m) (SMD: -0.65, 95% CI: -0.91 to -0.38, p < 0.00001, I² = 65%; 711 participants) and medium-term (1-3 m) (SMD: -0.42, 95% CI: -0.76 to -0.09, p = 0.01, I² = 69%; 489 participants) effects in reducing depression levels in MHD patients. Psychoeducational interventions that use coping strategies, goal setting, and relaxation techniques could enhance the QOL in MHD patients in the short term (< 1 m) (SMD: 0.86, 95% CI: 0.42 to 1.30, p = 0.02, I² = 86%; 241 participants).

Conclusions: Psychoeducational interventions have shown great potential to improve anxiety, depression, and quality of life in patients with MHD at the short- and medium-term follow-ups.Trial registration number: CRD42023440561.

Keywords: Maintenance hemodialysis; meta-analysis; psychoeducational interventions; quality of life; systematic review.

Figure 1.

Study selection flow diagram (according to PRISMA 2020 flow diagram for new systematic reviews).

Figure 2.

Forest plot of the meta-analysis of the effects of Psychoeducational interventions on anxiety in MHD patients one month after intervention.

Figure 3.

A Forest plot of the meta-analysis of the effects of Psychoeducational interventions on anxiety in MHD patients one to three months after intervention. Figure 3B Forest plot of the subgroup analysis of the effects of Psychoeducational interventions with psychological techniques of problem-solving.

Figure 4.

Forest plot of the meta-analysis of the effects of Psychoeducational interventions on depression in MHD patients one month after intervention.

Figure 5.

Forest plot of the meta-analysis of the effects of Psychoeducational interventions on depression in MHD patients one to three months after intervention.

Figure 6.

A Forest plot of the meta-analysis of the effects of Psychoeducational interventions on QOL in MHD patients one months after intervention. Figure 6B Forest plot of the subgroup analysis of the effects of Psychoeducational interventions with psychological techniques of coping strategies, goal setting and relaxation techniques.