The Effect of Cognitive Behavioral Therapy on Depression and Quality of Life in Chronic Kidney Disease Patients: A Quasi-Experimental Study

Nazaruddin Nazaruddin; Cece  Indriani; Icha  Novitasari; Akbar  Ramadhani

doi:10.56303/jhnresearch.v5i1.823

Authors

Nazaruddin Nazaruddin Faculty of Health Sciences, Mandala Waluya University, Kendari, Indonesia https://orcid.org/0000-0002-8786-7680
Cece Indriani Faculty of Health Sciences, Mandala Waluya University, Kendari, Indonesia
Icha Novitasari Faculty of Health Sciences, Mandala Waluya University, Kendari, Indonesia
Akbar Ramadhani Faculty of Health Sciences, Mandala Waluya University, Kendari, Indonesia

Keywords:

Beck Depression Inventory, Chronic Kidney Disease, Cognitive Behavioral Therapy, Depression, Quality of Life

Abstract

Chronic Kidney Disease (CKD) imposes substantial physical and psychological burdens, with depression significantly exacerbating the decline in patients' health-related quality of life (QOL). This study aimed to assess the efficacy of Cognitive Behavioral Therapy (CBT) in alleviating depressive symptoms and enhancing the QOL of CKD patients. Methods: A quasi-experimental study was conducted with 70 CKD patients experiencing depressive symptoms (BDI > 14), who were divided into intervention (n=35) and control (n=35) groups. The intervention group underwent an eight-week CBT program consisting of structured weekly sessions (30–60 minutes each), while the control group received routine medical care only. Depression and QOL were evaluated pre- and post-intervention using the Beck Depression Inventory (BDI) and the WHOQOL instrument, respectively. Analysis using the Mann-Whitney test showed a statistically significant improvement in the intervention group compared with the control group (p = 0.000). Following the intervention, 48.6% of participants in the CBT group transitioned to a "no depression" state, and 60.0% reported a "good" QOL, whereas the control group remained largely unchanged with high rates of severe depression. The integration of structured CBT into clinical nursing care provides a robust, holistic approach to improving the psychological and physical well-being of CKD patients. These results underscore the importance of incorporating routine mental health screening and evidence-based psychological interventions into standard renal care protocols.

Downloads

Download data is not yet available.

References

World Health Organization. Global health estimates: Disease Burden By Cause, Age, Sex, By Country And By Region. Geneva. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates: 2021

Republic of Indonesia Ministry of Health. National Basic Health Survey Report. Jakarta;2022

Southeast Sulawesi Provincial Health Office. Health Profile of Southeast Sulawesi Province. Kendari, Sulawesi Tenggara;

Nazaruddin N, Indriani C, Helthy H, Lisnawati L, Apriyanti A. Faktor-Faktor Yang Berhubungan Dengan Quality Of Life Pasien Gagal Ginjal Kronik. 2022;5.

Diéguez S, García-Llana H, Lobato D, Marín MT, Arenas MD, Dapena F, et al. Acceptance and Commitment Therapy For Depression In Chronic Kidney Patients: A Pilot Study. Front Psychol. 2025 Sept 5;16:1656929.

Goh ZS, Griva K. Anxiety and Depression In Patients With End-Stage Renal Disease: Impact And Management Challenges & Ndash; a narrative review. IJNRD. 2018 Mar;Volume 11:93–102.

Valsaraj BP. Cognitive Behaviour Therapy for Anxiety and Depression among People Undergoing Haemodialysis: A Randomized Control Trial. JCDR [Internet]. 2016 [cited 2025 Oct 10]; Available from: http://jcdr.net/article_fulltext.asp?issn=09739x&year=2016&volume=10&issue=8&page=VC06&issn=0973-709x&id=8383

González-Flores CJ, Garcia-Garcia G, Lerma C, Guzmán-Saldaña RME, Lerma A. Effect of Cognitive Behavioral Intervention Combined with the Resilience Model to Decrease Depression and Anxiety Symptoms and Increase the Quality of Life in ESRD Patients Treated with Hemodialysis. IJERPH. 2023 May 28;20(11):5981.

Mohamed SR, Awad S, Zaki SM. Effect of Cognitive Behavioral Therapy On Depressive Symptoms Among Patients Undergoing Hemodialysis. Egyptian Nursing Journal. 2024 Jan;21(1):62–72.

Nur Azizah As, Khairina, Artaria Tjempakasari, Khadijah Khairul Bariyah. Effect Of Cognitive-Behavioral Therapy on Depression in Chronic Kidney Disease Patients Undergoing Hemodialysis. JPS. 2024 Nov 1;13(2):189–96.

Yang H, Qi L, Pei D. Effect of Psychosocial Interventions For Depression In Adults With Chronic Kidney Disease: A Systematic Review And Meta-Analysis. BMC Nephrol. 2024 Jan 10;25(1):17.

Griva K, Chia JMX, Goh ZZS, Wong YP, Loei J, Thach TQ, et al. Effectiveness of a Brief Positive Skills Intervention To Improve Psychological Adjustment In Patients With End-Stage Kidney Disease Newly Initiated On Haemodialysis: protocol for a randomised controlled trial (HED-Start). BMJ Open. 2021 Sept;11(9):e053588.

Lv L, Han K, Meng L, Wang J, Yin H, Ren K, et al. Effects of Positive Psychological Interventions On Quality Of Life In Patients With First-Episode Depression. Front Psychiatry. 2025 July 25;16:1564225.

Sugiyono S. Mixed-method research methodology. Bandung: Alfabeta;2021

Hasnidar, Aswadi MW, Putra WUCJ. Family Support and Quality of Life for Chronic Kidney Disease (CKD) Patients Hemodialysis Therapy at Undata Hospital. JHNR. 2022 May 18;1(1):6–10.

Natale P, Palmer SC, Ruospo M, Saglimbene VM, Rabindranath KS, Strippoli GF. Psychosocial Interventions For Preventing And Treating Depression In Dialysis Patients. Cochrane Kidney and Transplant Group, editor. Cochrane Database of Systematic Reviews. 2019 Dec 2 [cited 2025 Oct 10]; Available from: https://doi.wiley.com/10.1002/14651858.CD004542.pub3

Nazaruddin N, Indriani C, Purnamasari A, Lestari SA. Family Issues In Caring For Patients With Chronic Kidney Failure. 2025;6(2).

Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol. 2021;52(2):98–107.

Zahra Z, Effendy E, Mawarpury M, Marthoenis M, Jaya I. Psychotherapies For Chronic Kidney Disease Patients With Hemodialysis: A systematic review of randomized control trials and quasi-experiments. Narra J. 2023 Dec 29;3(3):e215.

Ravaghi H, Behzadifar M, Behzadifar M, Mirghaed MT, Aryankhesal A, Salemi M, et al. Prevalence of Depression in Hemodialysis Patients in Iran.

Kukihara H, Yamawaki N, Ando M, Nishio M, Kimura H, Tamura Y. The Mediating Effect Of Resilience Between Family Functioning And Mental Well-Being In Hemodialysis Patients In Japan: a Cross-Sectional Design. Health Qual Life Outcomes. 2020 Dec;18(1):233.

Zegarow P, Manczak M, Rysz J, Olszewski R. The Influence Of Cognitive-Behavioral Therapy On Depression In Dialysis Patients – Meta-Analysis. aoms. 2020;16(6):1271–8.

Gregg LP, Hedayati SS. Pharmacologic and Psychological Interventions For Depression Treatment In Patients With Kidney Disease. Current Opinion in Nephrology & Hypertension. 2020 Sept;29(5):457–64.

Dember LM, Hsu JY, Mehrotra R, Cavanaugh KL, Kalim S, Charytan DM, et al. Pain Coping Skills Training for Patients Receiving Hemodialysis: The HOPE Consortium Randomized Clinical Trial. JAMA Intern Med. 2025 Feb 1;185(2):197.

Ling C, Evans D, Zhang Y, Luo J, Hu Y, Ouyang Y, et al. The Effects Of Cognitive Behavioural Therapy On Depression And Quality Of Life In Patients With Maintenance Haemodialysis: A Systematic Review. BMC Psychiatry. 2020 Dec;20(1):369.

Unggun Cahya Jalu Putra W, Yulianti S, Reza M. The Effect of Expressive Writing Therapy on Reducing Stress Levels in Chronic Kidney Disease Patients Undergoing Hemodialysis at Undata Hospital. JHNR. 2023 Apr 30;2(1):48–53.

Hernandez R, Wilund K, Solai K, Tamayo D, Fast D, Venkatesan P, et al. Positive Psychological Intervention Delivered Using Virtual Reality in Patients on Hemodialysis With Comorbid Depression: Protocol and Design for the Joviality Randomized Controlled Trial. JMIR Res Protoc. 2023 June 16;12:e45100.

Pratiwi SH, Sari EA, Kurniawan T. The Relationship between Health Literacy, Illness Perception, and Self-Management Adherence among Hemodialysis Patients in Indonesia. J Health Nutr Res. 2025 Aug 1;4(2):474–83.

Kim DS, Song HS, Lee KM, Lee JG, Yun S, Lim J, et al. The Effect Of A Scenario-Based Cognitive Behavioral Therapy Mobile App On End-Stage Kidney Disease Patients On Dialysis. Sci Rep. 2024 Sept 2;14(1):20339.