Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety.

Full Abstract

BACKGROUND: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function. OBJECTIVE: To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness. DESIGN: Randomized, controlled trial. METHODS: We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients' responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes. RESULTS: We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function. CONCLUSIONS: The intervention had a moderate effect on patient's emotional and functional outcomes that were observed during a critical period in patients' lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.

Author information

Author/s: McLaughlin, Thomas J (TJ); Aupont, Onesky (O); Bambauer, Kara Z (KZ); Stone, Peter (P); Mullan, Mariquita G (MG); Colagiovanni, Jane (J); Polishuk, Elaine (E); Johnstone, Michael (M); Locke, Steven E (SE);

Affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. Thomas.mclaughlin(-atsign-)umassmed.edu

Grants: MH-56217-05 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Journal of general internal medicine (J Gen Intern Med), published in United States. (Language: eng)

Reference: 2005-Dec; vol 20 (issue 12) : pp 1084-90

Dates: Created 2006/01/20; Completed 2006/07/25; Revised 2009/02/24;

PMID: 16423095, status: MEDLINE (last retrieval date: 3/9/2009, IMS Date: )

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