TUESDAY, March 8 (HealthDay News) -- People who've been
hospitalized for heart problems appear to suffer less depression
and anxiety in the weeks and months after discharge if they
participate in a basic depression management program before leaving
the hospital, a new study suggests.
"This is important because depression is common in heart disease patients, and it has been linked to more re-hospitalizations and higher death rates," noted the study's lead author, Dr. Jeff C. Huffman, an assistant professor of psychiatry at Harvard Medical School and director of the Cardiac Psychiatry Research Program at Massachusetts General Hospital in Boston.
"However, most cardiac patients have their depression go unrecognized and untreated," Huffman added. "A program like the one studied could identify depression in hospitalized heart patients and help them to not only get treatment for their heart disease but also treatment for the depression that could impair their recovery."
The findings were reported online March 7 in
Circulation: Cardiovascular Quality and Outcomes.
The American Heart Association recommends depression screening
for heart disease patients and, for those diagnosed with the
condition, some type of coordinated treatment, the authors noted.
But, they said, typical in-hospital intervention involves nothing
more than a recommendation to seek mental health treatment upon
discharge. Most in-depth depression management programs are limited
to outpatient settings.
To explore the potential of an in-hospital collaborative care
program, Huffman and his fellow researchers focused on 175 people
on the verge of being discharged from a hospital after treatment
for acute coronary syndrome, arrhythmia or heart failure. They were
screened for depression and then randomly assigned to receive
either standard care or to participate in a depression management
In the program, a psychiatrist developed individualized
treatment recommendations and, together with the patient's other
doctors, coordinated prescriptions and therapy referrals. Care
managers -- who were not doctors -- acted as facilitators between
the patients, their doctors and the psychiatrist. They provided
educational material on depression, including treatment options, to
the participants, and helped them schedule "pleasurable
activities." Care managers also coordinated inpatient and
outpatient care, based on the psychiatrist's and medical doctors'
By six weeks after discharge, people in the collaborative care
program were faring much better on all measures of mental health.
Depression symptoms were cut in half for about 60 percent of those
in the collaborative program, compared with 30 percent of the
others. Outcomes remained significantly better among program
participants at the three-month mark as well, the study found.
Six months after discharge, which was three months after the
program ended, the groups' scores on depression rating scales more
closely resembled each other, and re-hospitalization rates were
However, those who had participated in the program were far more
likely to have stuck to their recommended diet and exercise
regimen, the study found. They were also less likely to experience
cardiac symptoms, and symptoms that did develop were far less
The team concluded that a minimal amount of hospital resources
and time devoted toward depression care appeared to have a big
What's more, the researchers noted, the post-discharge treatment
intervention was shorter and less intense than most out-patient
management programs, which often involve weekly or biweekly
in-person assessments. By contrast, the tested program involved no
more than three phone contacts between hospital staff and patients
over the course of the 12-week program.
"An even more complete and intensive program might lead to even larger or longer improvements in these heart disease patients," Huffman suggested.
Bradi B. Granger, director of the nursing research program and a
clinical nurse specialist at the Duke University Heart Center in
Durham, N.C., described the effort to address depression related to
heart disease as "a great idea, because we know that depression is
common in patients following these kind of cardiovascular
"Aside from prior depression history, just having an acute coronary syndrome itself raises the risk, in part due to the whole new set of expectations and rules in terms of lifestyle and diet that arise, which are often hard to adopt at a certain point in life," Granger said.
People going through this need to recognize "that what they feel
is normal," she added. "They are not alone, and it is not unusual."
That's why, she said, "I think it's wonderful that there's a new
intervention that seems, at face value, to be relatively
inexpensive and short-term and effective."
The Cleveland Clinic has more on
heart disease and depression.
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