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Cited by 228Cardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCancer survivorship and care

Treatment of Depression After Coronary Artery Bypass Surgery: A Randomized Controlled Trial

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Freedland, Kenneth E., Skala, Judith A., Carney, Robert M., Rubin, Eugene H., Lustman, Patrick J., Dávila-Román, Victor G., Steinmeyer, Brian C., Hogue, Charles W.·2009·Archives of General Psychiatry
DOI 10.1001/archgenpsychiatry.2009.7PMC PMC5550769
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Abstract

CONTEXT: There has been little research on the treatment of depression after coronary artery bypass surgery. OBJECTIVE: To test the efficacy of 2 nonpharmacological interventions for depression after coronary artery bypass surgery compared with usual care. DESIGN: A 12-week, randomized, single-blind clinical trial with outcome evaluations at 3, 6, and 9 months. SETTING: Outpatient research clinic at Washington University School of Medicine, St Louis, Missouri. PATIENTS: One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery. INTERVENTION: Twelve weeks of cognitive behavior therapy or supportive stress management. Approximately half of the participants were taking nonstudy antidepressant medications. MAIN OUTCOME MEASURE: Remission of depression, defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression. RESULTS: Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy (71%) and supportive stress-management (57%) arms than in the usual care group (33%) (chi(2)(2) = 12.22, P = .002). Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy (mean [standard error], 5.5 [1.0]) and the supportive stress-management (7.8 [1.0]) arms than in the usual care arm (10.7 [1.0]) at 3 months. The differences narrowed at 6 months, but the remission rates differed again at 9 months (73%, 57%, and 35%, respectively; chi(2)(2) = 12.02, P = .003). Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression, anxiety, hopelessness, stress, and quality of life. Supportive stress management was superior to usual care only on some of the measures. CONCLUSIONS: Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery, relative to usual care. Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00042198.

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  • Other trials of psychotherapy have sometimes, but not universally, been associated with improvements in depression, and they have not been powered to examine cardiac events.

    “Other trials of psychotherapy have sometimes, but not universally, been associated with improvements in depression, and they have not been powered to examine cardiac events. 176,185”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [185]

    The COMMENT section reports that CBT and supportive stress management improved depression relative to usual care, supporting this paper as an example of a psychotherapy trial with positive results. The METHODS statistical-analysis passage describes depression outcomes, and the COMMENT notes limited power for treatment comparisons, but our copy does not explicitly assess power to examine cardiac events. This trial alone also does not establish that results across other trials were not universal. (LLM, conf=0.80)

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  • Cognitive behavioral therapy in patients with heart failure with major depression was associated with significant improvements in depression and other mental health outcomes but not in heart failure self-care.

    “Cognitive behavioral therapy in patients with heart failure with major depression was likewise associated with significant improvements in depression and other mental health outcomes but not in heart failure self-care.”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [185]

    The Results and Comment report that CBT improved depression and other psychological outcomes compared with usual care. But this trial studied patients after coronary artery bypass surgery, not a heart-failure population, and our copy does not report heart-failure self-care as an outcome. The claimed lack of improvement in self-care is therefore unsupported by this source. (LLM, conf=0.90)

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  • Cognitive behavioral therapy was associated with lower rates of hospitalization at 1 year compared with usual care (incidence rate ratio, 0.47; 95% CI, 0.30-0.76).

    “Cognitive behavioral therapy was also associated with lower rates of hospitalization at 1 year compared with usual care (incidence rate ratio, 0.47 [95% CI, 0.30-0.76]). 185”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [185]

    The Results sections report depression and psychological outcomes through 9 months, not hospitalization rates at 1 year. Searches for hospitalization, hospital admission, and the stated incidence rate ratio found no passage in our copy addressing the claimed outcome. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy or SSRIs, but evidence for a beneficial effect on cardiac endpoints is inconclusive.

    “Coronary patients with clinically significant depression can be safely and effectively treated with psychotherapy 84,85,351 -353 or selective serotonin re-uptake inhibitors, 354 -356 although evidence for a beneficial effect on cardiac endpoints is inconclusive.”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [353]

  • Most studies showed no significant beneficial effect of treating depression on cardiac endpoints, but a recent RCT revealed fewer depressive symptoms and fewer major adverse cardiac events.

    “Whereas most studies could show no significant beneficial effect, 84,351 -356 a recent RCT revealed fewer depressive symptoms as well as fewer major adverse cardiac events.85”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [353]

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Authors
Freedland, K. E., Skala, J. A., Carney, R. M., Rubin, E. H., Lustman, P. J., Dávila-Román, V. G., Steinmeyer, B. C., & Hogue, C. W.
Affiliations
  • Washington University in St. Louis (US)
  • Johns Hopkins University (US)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2009-04-01
Volume
66
Issue
4
Pages
387
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archgenpsychiatry.2009.7
PMC
PMC5550769
OpenAlex
W2020027855
Cited by
228
References
68
Citations by year
2026: 4 · 2025: 10 · 2024: 9 · 2023: 9 · 2022: 13 · 2021: 9 · 2020: 9 · 2019: 10 · 2018: 17 · 2017: 14 · 2016: 17 · 2015: 11 · 2014: 9 · 2013: 21 · 2012: 16
FWCI
13.59
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL064600)
  • National Institute of Mental Health (R01MH060735, R21MH052629)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
postoperative depression, coronary artery bypass grafting, cognitive behavioral therapy, depression remission, anxiety, hopelessness, quality of life, cardiac surgery patients
MeSH terms
Aged, Coronary Artery Bypass, Counseling, Major Depressive Disorder, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Personality Inventory, Postoperative Complications, Psychometrics, Social Support, Cognitive Behavioral Therapy, Single-Blind Method

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