A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD) - rationale and design of a multicenter, randomized trial in depressed patients with CAD

Area of Science:

• Cardiology
• Psychiatry
• Psychotherapy Research

Background:

• Depressive symptoms significantly impact quality of life, health behaviors, and prognosis in coronary artery disease (CAD) patients.
• Previous psychotherapy trials for depressed CAD patients showed limited effects on depression and no impact on cardiac events.
• The Type D pattern, characterized by negative affectivity and social inhibition, is common in CAD patients.

Purpose of the Study:

• To evaluate the efficacy of a stepwise psychotherapy intervention for treating depressive symptoms and the Type D pattern in patients with CAD.
• To assess the impact of the intervention on cardiac events, remission of depressive disorder, and health-related quality of life.

Main Methods:

• A multicentre randomized controlled trial involving 569 CAD patients with depression (Hospital Anxiety and Depression Scale [HADS] score ≥ 8).
• Patients were randomized (1:1) to receive either a stepwise psychotherapy intervention or a single psychosocial counseling session (control group).
• The intervention group received initial supportive individual psychotherapy, followed by combined psychodynamic and cognitive-behavioral group therapy for persistent symptoms.

Main Results:

• The primary efficacy variable is the change in HADS depression scores from baseline to 18 months.
• Secondary endpoints include cardiac events, remission of depressive disorder and Type D pattern, quality of life, cardiovascular risk profile, and health care utilization up to 24 months.

Conclusions:

• The study aims to provide evidence for an effective psychotherapy approach for comorbid depression and Type D personality in CAD patients.
• Findings are expected to inform clinical practice and improve outcomes for this vulnerable patient population.