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Sequential Interventions for Major Depression and Heart Failure Self-Care: A Randomized Clinical Trial
Kenneth E Freedland1, Judith A Skala1, Robert M Carney1
1Department of Psychiatry (K.E.F., J.A.S., R.M.C., B.C.S., E.H.R.), Washington University School of Medicine, St. Louis, MO.
Circulation. Heart Failure
|August 16, 2022
Summary
Cognitive behavior therapy (CBT) effectively treats major depression in heart failure (HF) patients. However, starting CBT before a tailored HF self-care intervention did not enhance self-care benefits.
Area of Science:
- Cardiology
- Psychiatry
- Behavioral Science
Background:
- Major depression and poor self-care are prevalent in heart failure (HF) patients.
- Effective interventions for co-occurring depression and inadequate self-care in HF are not well-established.
- This study investigated a sequential treatment approach for these dual issues.
Purpose of the Study:
- To evaluate the efficacy of cognitive behavior therapy (CBT) compared to usual care (UC) for major depression in patients with HF.
- To determine if initiating CBT before a tailored HF self-care intervention impacts the effectiveness of the self-care intervention.
Main Methods:
- A single-site, single-blind, randomized controlled trial (RCT) was conducted.
- Participants with HF and major depression received either CBT or UC for depression.
- Both groups received a tailored HF self-care intervention starting 8 weeks post-randomization.
Main Results:
- Patients receiving CBT showed a statistically significant reduction in depressive symptoms (Beck Depression Inventory, version 2) compared to UC at 16 weeks (P=0.02).
- No significant difference was observed in the self-care intervention outcomes between the CBT and UC groups at 16 weeks.
Conclusions:
- Cognitive behavior therapy (CBT) is an effective treatment for major depression in heart failure patients.
- A sequential approach, initiating CBT before a tailored self-care intervention, did not yield additional benefits for self-care in HF patients.
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