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A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD): Results of an
Christoph Herrmann-Lingen1, Manfred E Beutel, Alexandra Bosbach
1From the Department of Psychosomatic Medicine and Psychotherapy (Herrmann-Lingen, Bosbach), University of Göttingen Medical Center and German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany; Department of Psychosomatic Medicine and Psychotherapy (Beutel, Michal), University Medical Center Mainz, Mainz, Germany; Department of Psychosomatics and Psychotherapy (Deter, Weber), Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy (Fritzsche), University Medical Center Freiburg, Freiburg, Germany; Institute of Medical Statistics (Hellmich), Informatics and Epidemiology, University of Cologne, Köln, Germany; Clinic of Psychocardiology (Jordan), Kerckhoff Rehabilitation Center, Bad Nauheim, Germany; Department of General Internal and Psychosomatic Medicine (Jünger), University of Heidelberg, Heidelberg, Germany; Institute of Epidemiology (Ladwig), Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany; Department of Psychotherapy and Psychosomatics (Petrowski), Technical University of Dresden, Dresden, Germany; Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Internal Medicine and Cardiology, German Heart Cente, and German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany (Pieske); Department of Psychosomatic Medicine and Psychotherapy (Ronel), University Hospital Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy (Söllner), Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany; Clinical Trials Center (Stöhr), University of Cologne, Köln, Germany; Department of Psychosomatic Medicine and Psychotherapy (de Zwaan), Hannover Medical School, Hannover, Germany; and Department of Psychosomatics and Psychotherapy (Albus),
Insights
Stepwise psychotherapy did not significantly improve depression in coronary artery disease (CAD) patients compared to information sessions. However, Type D personality may predict a better response to psychotherapy in these patients.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Psychology
Background:
- Depression is linked to worse outcomes in coronary artery disease (CAD) patients.
- Previous studies on treating depression in CAD have shown inconsistent results.
Purpose of the Study:
- To test if stepwise psychotherapy is more effective than simple information for improving depressive symptoms in CAD patients.
- To investigate if patient sex or Type D personality influences treatment response.
Main Methods:
- A multicenter trial randomized 570 CAD patients with elevated depressive symptoms.
- Patients received usual care plus either one information session (UC-IS) or stepwise psychotherapy (UC-PT).
- The primary outcome was the change in depressive symptoms over 18 months, with subgroup analyses for sex and Type D personality.
Main Results:
- Both UC-PT and UC-IS groups showed significant reductions in depressive symptoms (p < .001).
- There was no significant overall difference in symptom improvement between the two groups (p = .90).
- A significant interaction was found for Type D personality (p = .026), with a trend towards greater improvement with UC-PT in Type D patients (p = .057).
Conclusions:
- Stepwise psychotherapy did not outperform simple information sessions in reducing depressive symptoms in CAD patients.
- Type D personality may identify CAD patients who could benefit more from stepwise psychotherapy.
- Further research is needed to confirm the efficacy of psychotherapy for Type D CAD patients.
Background:
Depression predicts adverse prognosis in patients with coronary artery disease (CAD), but previous treatment trials yielded mixed results. We tested the hypothesis that stepwise psychotherapy improves depressive symptoms more than simple information.
Methods:
In a multicenter trial, we randomized 570 CAD patients scoring higher than 7 on the Hospital Anxiety and Depression Scale-depression subscale to usual care plus either one information session (UC-IS) or stepwise psychotherapy (UC-PT). UC-PT patients received three individual psychotherapy sessions. Those still depressed were offered group psychotherapy (25 sessions). The primary outcome was changed in the Hospital Anxiety and Depression Scale-depression scores from baseline to 18 months. Preplanned subgroup analyses examined whether treatment responses differed by patients' sex and personality factors (Type D).
Results:
The mean (standard deviation) depression scores declined from 10.4 (2.5) to 8.7 (4.1) at 18 months in UC-PT and from 10.4 (2.5) to 8.9 (3.9) in UC-IS (both p < .001). There was no significant group difference in change of depressive symptoms (group-by-time effect, p = .90). Preplanned subgroup analyses revealed no differences in treatment effects between men versus women (ptreatment-by-sex interaction = .799) but a significant treatment-by-Type D interaction on change in depressive symptoms (p = .026) with a trend for stronger improvement with UC-PT than UC-IS in Type D patients (n = 341, p = .057) and no such difference in improvement in patients without Type D (n = 227, p = .54).
Conclusions:
Stepwise psychotherapy failed to improve depressive symptoms in CAD patients more than UC-IS. The intervention might be beneficial for depressed CAD patients with Type D personality. However, this finding requires further study.
Trial Registration:
www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576.
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