Early cognitive behavioral therapy for depression after cardiac surgery
| Autor: | Rebecca Cross Bodán, Adey Nyamathi, Marise C. Magsarili, Belinda Chen, Michael R. Irwin, Lynn V. Doering |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Population behavioral disciplines and activities Article law.invention Randomized controlled trial law Internal medicine mental disorders medicine Humans Cardiac Surgical Procedures Psychiatry education Depression (differential diagnoses) Advanced and Specialized Nursing education.field_of_study Cognitive Behavioral Therapy business.industry Depression Beck Depression Inventory Middle Aged Confidence interval Cardiac surgery Cognitive behavioral therapy Number needed to treat Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of cardiovascular nursing. 28(4) |
| ISSN: | 1550-5049 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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