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Number of group psychotherapy sessions predicts inflammation changes in patients with coronary artery disease and
Joram Ronel1, Elisabeth Olliges2, Christoph Herrmann-Lingen3
1Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG, Barmelweid, Switzerland; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Insights
Group psychotherapy significantly reduced inflammatory markers and depression in patients with coronary artery disease (CAD). More sessions correlated with lower inflammatory burden, suggesting a key role for psychotherapy in managing comorbid conditions.
Area of Science:
- Cardiology
- Psychiatry
- Immunology
Background:
- Inflammation is a key factor in the link between depression and coronary artery disease (CAD).
- The effect of group psychotherapy on inflammation in CAD patients with depression remains unclear.
Purpose of the Study:
- To investigate the impact of group psychotherapy on inflammatory markers in CAD patients with comorbid depression.
Main Methods:
- 337 CAD patients from the SPIRR-CAD trial participated.
- Data on inflammatory markers (hsCRP, TNF-α, IL-6) and depression scores were collected at baseline and 18-month follow-up.
- Patients received either group psychotherapy (up to 25 sessions) or usual care.
Main Results:
- Prevalence of elevated hsCRP, TNF-α, and depression scores significantly decreased from baseline to follow-up.
- An inflammatory factors score (IFS) also significantly decreased.
- Patients with 10-25 psychotherapy sessions had a 4.59-fold higher chance of reduced IFS compared to those with 1-9 sessions, even after adjustments.
Conclusions:
- Group psychotherapy significantly impacts inflammatory factors score (IFS) changes in CAD patients with persistent depression.
- A higher number of psychotherapy sessions is associated with a reduced inflammatory burden, independent of other factors like diabetes.
Objective:
Inflammation contributes to the bidirectional relationship between depression and coronary artery disease (CAD). However, the impact of group psychotherapy on inflammatory levels in CAD patients with comorbid depression has not been elucidated.
Methods:
A total of 337 patients (average age 59.2 years ±9.4, 80.4% male) from the SPIRR-CAD trial provided results of questionnaires and inflammatory data at baseline (T0) and the 18-month follow-up (T3) of a group psychotherapy program, with a maximum of 25 sessions vs. usual care.
Results:
At baseline, inflammatory parameters were elevated for high-sensitivity C-reactive protein (hsCRP) in 41.2%, tumor necrosis factor-α (TNF-α) in 33.2% and interleukin-6 (IL-6) in 21.1% of all patients. From T0 to T3, prevalences of elevated hsCRP (p = .027), TNF-α (p = .013) and depression scores (measured with the Hamilton Depression Rating-Scale; (p = .002) significantly decreased in all patients. Additionally, an inflammatory factors score (IFS), calculated from the inflammatory parameters showed a significant decrease between T0 and T3 (p = .046) in all patients. A blockwise multivariate logistic regression analysis revealed a 4.59-fold higher chance of IFS reduction (or stable low values) for patients with a higher number (10-25) of group psychotherapy sessions (OR = 4.59, 95% CI: 1.39-15.1, p = .012) compared to patients with 1-9 sessions, even after adjusting for comorbidities or pharmacological antidepressant treatment.
Conclusion:
This analysis demonstrates a significant impact of group psychotherapy sessions on IFS changes in CAD patients with persistently elevated depression scores. Beyond the influence of the absence of diabetes mellitus, a higher number of group psychotherapy sessions reduces the risk of inflammatory burden.
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