OBJECTIVES: Poor adherence and higher distress are common in patients on dialysis. This randomised controlled trial therefore aimed to evaluate the effectiveness of a brief self-management intervention (HEDSMART) on clinical and psychological outcomes. METHODS: A total of 235 haemodialysis (HD) patients were randomised to HEDSMART or standard care. Changes in symptoms of depression and anxiety over time, up to 12 months' follow-up, were explored as secondary outcomes. Latent Class Growth Analysis was employed to identify longitudinal trajectories of symptoms, demographic and clinical predictors of these trajectories, and possible effects of HEDSMART.  RESULTS: Analyses indicated two markedly different classes of symptom progression for both depression and anxiety: a low stable class characterised by non-clinical levels of distress (resilience), and a persistent high distress class characterised by consistently high, i.e., clinically significant symptoms, over the 12 months (chronic distress). Patients who were older (OR = 1.09, 95% CI = 1.04–1.14), non-Chinese (OR = .36, 95% CI = .20–.67), or had fewer co-morbidities (OR = .77, 95% CI = .64–.91), were more likely to be in the resilience trajectory for depression; older age (OR = 1.06, 95% CI = 1.02–1.09), and longer dialysis vintage (OR = 1.09, 95% CI = 1.02 –1.16), were also shown to be associated with resilience in terms of anxiety. Significant effects were shown for HEDSMART. Regardless of latent class membership, HEDSMART significantly predicted decreases in depressive symptoms (Est