People have fewer, less severe problems with early, collaborative care, study finds
By Alan Mozes
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 program.
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' guidelines.
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 similar.
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 severe.
The team concluded that a minimal amount of hospital resources and time devoted toward depression care appeared to have a big payoff.
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 events."
"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."