Early cognitive behavioral therapy for depression after cardiac surgery.

TitleEarly cognitive behavioral therapy for depression after cardiac surgery.
Publication TypeJournal Article
Year of Publication2013
AuthorsDoering LV, Chen B, Bodán RCross, Magsarili MC, Nyamathi A, Irwin MR
JournalJ Cardiovasc Nurs
Date Published2013 Jul-Aug
KeywordsCardiac Surgical Procedures, Cognitive Therapy, Depression, Female, Humans, Male, Middle Aged, Time Factors

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.

Alternate JournalJ Cardiovasc Nurs
PubMed ID22635060
PubMed Central IDPMC3434264
Grant ListR01 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