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Published on: December 7, 2016
Effect of text messaging on depression in patients with coronary heart disease: a substudy analysis from the TEXT ME
Sheikh Mohammed Shariful Islam1,2,3, Clara K Chow1,2,4, Julie Redfern1,2
1The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Mobile text messages significantly reduced depression symptoms in coronary heart disease patients. This lifestyle program improved mental well-being without specific mental health interventions.
Area of Science:
- Cardiology
- Digital Health
- Mental Health
Background:
- Coronary heart disease (CHD) patients often experience depression.
- Lifestyle factors significantly impact cardiovascular health and mental well-being.
Purpose of the Study:
- To assess the impact of a mobile text message-based cardiac support program on depression scores in CHD patients.
Main Methods:
- A randomized controlled trial involving patients with CHD.
- Intervention group received four weekly text messages for six months covering diet, exercise, and cardiac health.
- Depression assessed using Patient Health Questionnaire-9 (PHQ-9) at six months.
Main Results:
- The intervention group showed significantly lower depression scores (mean difference 1.9, p<0.0001).
- Mild or greater depressive symptoms (PHQ-9 ≥5) were reduced from 24.6% to 6.3% (RR 0.26, p<0.001).
- Benefits were consistent across various subgroups, including those with a history of depression.
Conclusions:
- A lifestyle-focused cardiac support program delivered via mobile text messaging effectively reduced depression symptoms in CHD patients.
- The program demonstrated significant benefits regardless of prior mental health history or other demographic factors.
Objective:
We aimed to evaluate the effects on depression scores of a lifestyle-focused cardiac support programme delivered via mobile phone text messaging among patients with coronary heart disease (CHD).
Design:
Substudy and secondary analysis of a parallel-group, single-blind randomised controlled trial of patients with CHD.
Setting:
A tertiary hospital in Sydney, Australia.
Intervention:
The Tobacco, Exercise and dieT MEssages programme comprised four text messages per week for 6 months that provided education, motivation and support on diet, physical activity, general cardiac education and smoking, if relevant. The programme did not have any specific mental health component.
Outcomes:
Depression scores at 6 months measured using the Patient Health Questionnaire-9 (PHQ-9). Treatment effect across subgroups was measured using log-binomial regression model for the binary outcome (depressed/not depressed, where depressed is any score of PHQ-9 ≥5) with treatment, subgroup and treatment by subgroup interaction as fixed effects.
Results:
Depression scores at 6 months were lower in the intervention group compared with the control group, mean difference 1.9 (95% CI 1.5 to 2.4, p<0.0001). The frequency of mild or greater depressive symptoms (PHQ-9 scores≥5) at 6 months was 21/333 (6.3%) in the intervention group and 86/350 (24.6%) in the control group (relative risk (RR) 0.26, 95% CI 0.16 to 0.40, p<0.001). This proportional reduction in depressive symptoms was similar across groups defined by age, sex, education, body mass index, physical activity, current smoking, current drinking and history of depression, diabetes and hypertension. In particular, the rates of PHQ-9 ≥5 among people with a history of depression were 4/44 (9.1%) vs 29/62 (46.8%) in intervention vs control (RR 0.19, 95% CI 0.07 to 0.51, p<0.001), and were 17/289 (5.9%) vs 57/288 (19.8%) among others (RR 0.30, 95% CI 0.18 to 0.50, p<0.001).
Conclusions:
Among people with CHD, a cardiac support programme delivered via mobile phone text messaging was associated with fewer symptoms of mild-to-moderate depression at 6 months in the treatment group compared with controls.
Trial Registration Number:
ACTRN12611000161921.
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