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Randomized Controlled Trial
. 2013 Jul-Aug;28(4):370-9.
doi: 10.1097/JCN.0b013e31824d967d.

Early cognitive behavioral therapy for depression after cardiac surgery

Lynn V Doering  1 , Belinda Chen, Rebecca Cross Bodán, Marise C Magsarili, Adey Nyamathi, Michael R Irwin
Affiliations
Randomized Controlled Trial

Early cognitive behavioral therapy for depression after cardiac surgery

Lynn V Doering et al. J Cardiovasc Nurs. 2013 Jul-Aug.

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.

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Conflict of interest statement

Conflicts of Interest and Financial Disclosures: None

Figures

Figure 1
Figure 1
Flowchart of study participants
Figure 2
Figure 2
Change in BDI Severity within Groups Abbreviations: CBT = Early Cognitive Behavioral Therapy; UC = Usual Care, UC+CBT = Later CBT completed after usual care; ap values computed using McNemar-Bowker test.
See this image and copyright information in PMC

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