Objectives: Kidney transplantation (KT) improves prognosis not only physically but also psychologically in patients with end-stage kidney disease (ESKD). However, there are few comparative studies of psychiatric disorders in patients treated with dialysis and KT in patients with ESKD. Methods: 21,809 ESKD patients without depression and insomnia history before starting renal replacement therapy between January 2002- December 2018 were extracted from the Korean National Health Insurance Service database.  Results: 17,649 patients received dialysis (15,537 patients received hemodialysis, 2,112 patients received peritoneal dialysis), and 4,160 patients received KT. 45.04% (7,949) dialysis patients suffer from insomnia whereas 25.72% (1,070) KT recipients suffer from insomnia (p<0.001). Compared to KT recipients (8.61%, 358), dialysis patients (22.77%, 4,019) were more prescribed anti-depressant medication (p<0.001). Compared KT recipients (0.12%, 5), dialysis patients (0.19%, 33) were more completely suicided (p=0.047).  In multivariate-adjusted analysis, the hazards ratio (HR) of depression was 1.82 (95% confidence interval (CI)s, 1.62-2.04).  In subgroup analysis insomnia patients (HR 2.15, 95% CI 1.86-2.47), living in rural areas (HR 2.04, 95% CI 1.70-2.36), male patients (HR 1.85 95% CI 1.61-2.13), aged under 65 years old patients (HR 1.90 95% CI 1.68-2.14) more prescribed anti-depressant medication.  Conclusions: KT patients have a lower suicide rate than dialysis patients. In addition, KT is effective in reducing the prevalence of depression in patients with ESKD in Korea, especially for insomnia patients, living in rural areas, male patients, and those aged under 65 years old.