title: The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: a randomized controlled trial.
abstract: BACKGROUND
  Patients with end stage renal disease on hemodialysis are affected by physiological and psychological stressors, which contribute to poor quality of life and negative clinical outcomes. Depression, anxiety, and stress are highly prevalent in this population. Effective interventional strategies are required to manage these psychological symptoms. Acupressure has been believed to be one of the complementary therapies that could promote psychological wellbeing.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effects of acupressure on depression, anxiety, stress, and general psychological distress in patients with hemodialysis.
  
  
  METHODS
  Open-label randomized controlled trial.
  
  
  METHODS
  Three hemodialysis centers.
  
  
  METHODS
  A total of 108 patients with hemodialysis were randomly recruited into the acupressure group (n=54) and the control group (n=54).
  
  
  METHODS
  The intervention was carried out from January to March 2014. The acupressure group received routine hemodialysis treatment plus 15 min acupressure applied three times a week for four weeks. The control group received only usual care with routine hemodialysis treatment. The outcome measurements were the Depression, Anxiety Stress Scales (DASS-21), and general psychological distress using the General Health Questionnaire (GHQ-28). Statistical analysis was performed using Wilcoxon signed-rank test to compare DASS scales and GHQ-28 scores before and after acupressure intervention.
  
  
  RESULTS
  The acupressure group had significantly lower DASS scores and GHQ scores compared to the control group, signifying improvements in depression, anxiety, stress and general psychological distress. The sub-score of the GHQ-28 for social dysfunction, however, were similar in both groups.
  
  
  CONCLUSIONS
  Findings from this study indicates that acupressure therapy delivered three times a week for four weeks was able to significantly reduce depression, anxiety, stress, and general psychological distress in patients with hemodialysis. This positive finding suggests that acupressure may have a role in promoting psychological wellbeing of patients. Promoting psychological wellness will improve patients' quality of life, and reduce negative outcomes associated with psychological illnesses and distress experienced by patients with hemodialysis.
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: aprial.thin@gmail.com.
authors.forename: Nant Thin Thin
authors.initials: NT
authors.lastname: Hmwe
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: pathmawathi@um.edu.my.
authors.forename: Pathmawathi
authors.initials: P
authors.lastname: Subramanian
authors.affiliation: Nephrology Division, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: liping_t@um.edu.my.
authors.forename: Li Ping
authors.initials: LP
authors.lastname: Tan
authors.affiliation: Faculty of Medicine & Health Sciences, University Tunku Abdul Rahman, Sungai Long, Cheras, Malaysia. Electronic address: chongwk@utar.edu.my.
authors.forename: Wan Kuan
authors.initials: WK
authors.lastname: Chong
mesh_terms: D019050:Acupressure / Q000379:methods; D001007:Anxiety / Q000628:therapy*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Acupressure; Anxiety; Depression; Hemodialysis; Psychological; Renal dialysis; Stress