Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Tully, Phillip J.; Higgins, Rosemary

doi:10.1111/ap.12075

Cited by 13 publications

(6 citation statements)

References 86 publications

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“…Participants and their general physician will be informed of the baseline distress results and directed to available clinical services (psychologist or psychiatrist), advising participants to seek assistance for achieving mental wellbeing with the support of their general physician. This conforms to the National Heart Foundation of Australia’s™ guidelines [ 51 , 55 ]. There are no restrictions on usual care.…”

Section: Methodssupporting

confidence: 53%

Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial

Tully

Turnbull

Horowitz

et al. 2016

Trials

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BackgroundPrevious psychological and pharmacological interventions have primarily focused on depression disorders in populations with cardiovascular diseases (CVDs) and the efficacy of anxiety disorder interventions is only more recently being explored. Transdiagnostic interventions address common emotional processes and the full range of anxiety and depression disorders often observed in populations with CVDs. The aim of CHAMPS is to evaluate the feasibility of a unified protocol (UP) for the transdiagnostic treatment of emotional disorders intervention in patients recently hospitalized for CVDs. The current study reports the protocol of a feasibility randomized controlled trial to inform a future trial.Methods/DesignThis is a feasibility randomized, controlled trial with a single-center design. A total of 50 participants will be block-randomized to either a UP intervention or enhanced usual care. Both groups will receive standard CVD care. The UP intervention consists of 1) enhancing motivation, readiness for change, and treatment engagement; (2) psychoeducation about emotions; (3) increasing present focused emotion awareness; (4) increasing cognitive flexibility; (5) identifying and preventing patterns of emotion avoidance and maladaptive emotion-driven behaviors (EDBs, including tobacco smoking, and alcohol use); (6) increasing tolerance of emotion-related physical sensations; (7) interoceptive and situation-based emotion-focused exposure; and (8) relapse prevention strategies. Treatment duration is 12 to 18 weeks. Relevant outcomes include the standard deviation of self-rated anxiety, depression and quality of life symptoms. Other outcomes include intervention acceptability, satisfaction with care, rates of EDBs, patient adherence, physical activity, cardiac and psychiatric readmissions. Parallel to the main trial, a nonrandomized comparator cohort will be recruited comprising 150 persons scoring below the predetermined depression and anxiety severity thresholds.DiscussionCHAMPS is designed to evaluate the UP for the transdiagnostic treatment of emotional disorders targeting emotional disorder processes in a CVD population. The design will provide preliminary evidence of feasibility, attrition, and satisfaction with treatment to design a definitive trial. If the trial is feasible, it opens up the possibility for interventions to target broader emotional processes in the precarious population with CVD and emotional distress.Trial registrationACTRN12615000555550, registered on 29/05/2015

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Section: Methodssupporting

confidence: 53%

Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial

Tully

Turnbull

Horowitz

et al. 2016

Trials

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“…Depression is widely reported to lead to an adverse coronary heart disease (CHD) prognosis, 1 2 poorer quality of life (QOL) 3 4 and high healthcare costs. 5 Despite ongoing efforts to better identify and treat depression, 6 prior psychological and pharmacological interventions designed especially for the CHD population have reported markedly lower effect sizes than has been observed among other chronic diseases such as diabetes. 7 8 Moreover, large trials such as the landmark Enhancing Recovery in CHD (ENRICHD) study 9 did not lead to a significant reduction in major adverse cardiac events (MACE), raising questions about the design 10 and acceptability 11 of depression interventions in the population with CHD.…”

Section: Introductionmentioning

confidence: 99%

Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials

Tully

Baumeister

2015

BMJ Open

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ObjectivesTo systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.DesignSystematic review and meta-analysis.Data sourcesElectronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.Inclusion criteriaPopulation, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.Data extraction and analysisRevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.ResultsSix RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD −0.31; 95% CI −0.43 to −0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD −0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I2=76.5%).ConclusionsCollaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.Trials registration numberPROSPERO CRD42014013653.

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“…Although, based on the finding indicating significantly higher hospital readmission rates, one might also expect higher rates of cardiac-related diagnostic and revascularization procedures, however, findings were inconsistent. A potential explanation relates to evidence indicating that persons with mental disorders are suboptimally treated or referred for diagnostic procedures, less likely to receive optimal coronary revascularization strategies and are susceptible to patient-physician communication barriers [ 70 , 71 ]. Another possible explanation would be, that differences in invasive procedures may vary between patients samples (e.g.…”

Section: Discussionmentioning

confidence: 99%

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review

Baumeister

Haschke

Munzinger

et al. 2015

BioPsychoSocial Med

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BackgroundTo systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders.MethodsA comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots.ResultsThe literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from −0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from −0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive.ConclusionsComorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.

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Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Cited by 13 publications

References 86 publications

Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial

Cardiovascular Health in Anxiety or Mood Problems Study (CHAMPS): study protocol for a randomized controlled trial

Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review

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