Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Mar 8;20(3):e88.
doi: 10.2196/jmir.9710.

Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial

Fredrika Norlund  1 , Emma Wallin  2 , Erik Martin Gustaf Olsson  1 , John Wallert  1 , Gunilla Burell  3 , Louise von Essen  1 , Claes Held  1   4   5
Affiliations
Randomized Controlled Trial

Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial

Fredrika Norlund et al. J Med Internet Res. .

Abstract

Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups.

Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI.

Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.

Results: There was a reduction in HADS scores over time in the total study sample (mean delta=-5.1, P<.001) but no difference between the study groups at follow-up (beta=-0.47, 95% CI -1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module.

Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result.

Trial registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22).

Keywords: cardiac rehabilitation; eHealth; patient acceptance of health care; patient selection; treatment adherence and compliance.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flowchart of patients through the U-CARE Heart trial. iCBT: Internet-based cognitive behavioral therapy; HADS-D: Hospital Anxiety and Depression Scale-Depression subscale; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale.
Figure 2
Figure 2
Proportion of patients completing different number of steps in the internet-based cognitive behavioral therapy.
See this image and copyright information in PMC

References

    1. Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, Fauerbach JA, Bush DE, Ziegelstein RC. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006 Jan;21(1):30–8. doi: 10.1111/j.1525-1497.2005.00269.x. https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pu... - DOI - PMC - PubMed
    1. Roest AM, Martens EJ, Denollet J, de Jonge P. Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med. 2010 Jul;72(6):563–9. doi: 10.1097/PSY.0b013e3181dbff97. - DOI - PubMed
    1. Lane D, Carroll D, Ring C, Beevers DG, Lip GY. The prevalence and persistence of depression and anxiety following myocardial infarction. Br J Health Psychol. 2002 Feb;7(Pt 1):11–21. doi: 10.1348/135910702169321. - DOI - PubMed
    1. Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, de Jonge P. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. Gen Hosp Psychiatry. 2011;33(3):203–16. doi: 10.1016/j.genhosppsych.2011.02.007. https://linkinghub.elsevier.com/retrieve/pii/S0163-8343(11)00064-8 - DOI - PubMed
    1. Benyamini Y, Roziner I, Goldbourt U, Drory Y, Gerber Y, Israel Study Group on First Acute Myocardial Infarction Depression and anxiety following myocardial infarction and their inverse associations with future health behaviors and quality of life. Ann Behav Med. 2013 Dec;46(3):310–21. doi: 10.1007/s12160-013-9509-3. - DOI - PubMed

Publication types

Associated data