Early cognitive behavioral therapy for depression after cardiac surgery.
Title | Early cognitive behavioral therapy for depression after cardiac surgery. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Doering LV, Chen B, Bodán RCross, Magsarili MC, Nyamathi A, Irwin MR |
Journal | J Cardiovasc Nurs |
Volume | 28 |
Issue | 4 |
Pagination | 370-9 |
Date Published | 2013 Jul-Aug |
ISSN | 1550-5049 |
Keywords | Cardiac Surgical Procedures, Cognitive Therapy, Depression, Female, Humans, Male, Middle Aged, Time Factors |
Abstract | BACKGROUND: Despite high rates of postcardiac surgery depression, studies of depression treatment in this population have been limited. OBJECTIVE: The aim of this study was to evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. METHODS: : From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and 1 month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV; those who met criteria for clinical depression (n = 81) were randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of the UC period, 25 individuals were offered later CBT (UC + CBT). RESULTS: Main outcomes (depressive symptoms [BDI] and clinical depression [Structured Clinical Interview for DSM-IV]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. Compared with the UC group, in the CBT group, there was greater decline in BDI scores (β = 1.41; 95% confidence interval [CI], 0.81-2.02; P = < .001) and greater remission of clinical depression (29 [64%] vs 9 [25%]; number need to treat, 2.5; 95% CI, 1.7-4.9; P < .001). Compared with the early CBT group (median time from surgery to CBT, 45.5 days) the later UC + CBT group (median time from surgery to CBT, 122 days) also experienced a reduction in BDI scores, but the group × time effect was smaller (β = 0.79; 95% CI, 0.10-1.47; P = .03) and remission rates between the 2 groups did not differ. CONCLUSIONS: Early home CBT is effective in depressed postcardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery. |
DOI | 10.1097/JCN.0b013e31824d967d |
Alternate Journal | J Cardiovasc Nurs |
PubMed ID | 22635060 |
PubMed Central ID | PMC3434264 |
Grant List | R01 NR009228 / NR / NINR NIH HHS / United States R01 NR009228-01A1 / NR / NINR NIH HHS / United States R01NR009228 / NR / NINR NIH HHS / United States UL1 TR000124 / TR / NCATS NIH HHS / United States |