Elsevier

Journal of Psychosomatic Research

Volume 88, September 2016, Pages 36-41
Journal of Psychosomatic Research

Clinical predictors of depression treatment outcomes in patients with coronary heart disease

https://doi.org/10.1016/j.jpsychores.2016.07.011Get rights and content

Highlights

  • Cardiac patients who do not respond to depression treatment are at risk for mortality.

  • Patients with major depression and heart disease were treated for depression.

  • Financial and interpersonal stressors during treatment predicted depression outcomes.

  • Medical hospitalizations and medical emergencies did not.

  • Financial and interpersonal stressors should be addressed in depressed cardiac patients.

Abstract

Objectives

Patients with coronary heart disease (CHD) who respond to treatment for depression are at lower risk of mortality than are nonresponders. This study sought to determine whether variables that have been shown to predict both depression treatment outcomes in psychiatric patients and cardiac events in patients with CHD, also predict poor response to depression treatment in patients with CHD.

Methods

One hundred fifty-seven patients with stable CHD who met the DSM-IV criteria for a major depressive episode were treated with cognitive behavior therapy (CBT) for 16 weeks, either alone or in combination with an antidepressant.

Results

The mean Beck Depression Inventory (BDI-II) score was 30.2 ± 8.5 at baseline and 8.5 ± 7.8 at 16 weeks. Over 50% of the participants were in remission (HAM-D-17 score ≤ 7) at the end of treatment. Of the hypothesized predictors, severe depression at baseline (p = 0.02), stressful life events during the first (p = 0.03) and last (p < 0.0001) 8 weeks of treatment, and the completion of CBT homework assignments (p = 0.001) predicted depression outcomes. History of prior episodes, anxiety symptoms, antidepressant therapy at study enrollment, and medical hospitalizations or emergency department visits during treatment did not predict treatment outcome.

Conclusions

Patients who are under considerable stress do not respond as well to evidence-based treatments for depression as do patients with less stress. If future studies support these findings, more work will be needed to better address stressful life events in patients who may otherwise remain at high risk for mortality and medical morbidity following depression treatment.

Section snippets

Eligibility screening and recruitment

Patients were recruited between May 2009 and August 2013 at cardiology offices and diagnostic laboratories affiliated with Washington University School of Medicine and Barnes-Jewish Hospital of St. Louis. Consenting patients with CHD documented by coronary angiography, a history of coronary revascularization, or hospitalization for ACS, completed the Patient Health Questionnaire (PHQ-9) [27]. Patients were excluded from the study if they refused to participate or if their physician did not

Results

Five hundred seventy-one patients with documented CHD were screened for eligibility. Of these, 157 (27%) had major depression, met all study criteria, and provided written informed consent. Of the enrolled participants, 126 (80%) completed all requirements of the study including the recommended number of CBT sessions and all post-treatment assessments. Those who did not complete all study requirements were less likely to have finished high school (80% vs. 96%; p = 0.002) and to be Caucasian (70%

Discussion

Clinical trials have found that patients with CHD who have a poor response to standard depression treatments experience higher rates of cardiac morbidity and mortality than those whose depression symptoms improve [7], [8], [9], [10], [11], [12]. Little is known about predictors of response to depression treatment in patients with CHD. In this study, the pre-treatment severity of depression predicted post-treatment BDI-II scores, suggesting that severe depression in patients with CHD may be less

Competing interest statement

All authors have completed the Unified Competing Interest form and declare that they have only received support from the National Institutes of Health, USA, for the submitted work. Dr. Carney or a member of his family owns stock in Pfizer, Inc. The other authors report no potential relevant conflicts of interest.

Acknowledgements

This research study was supported by grant number R01HL089336 from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland. The authors thank Patricia Herzing, RN; Iris Csik, ACSW; Jessica McDaniel, MA; Carol Sparks, LPN; and Kimberly Metze, BS for their contributions to the study.

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