Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety

J Gen Intern Med. 2005 Dec;20(12):1084-90. doi: 10.1111/j.1525-1497.2005.00256.x.

Abstract

Background: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function.

Objective: To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness.

Design: Randomized, controlled trial.

Methods: We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients' responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes.

Results: We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function.

Conclusions: The intervention had a moderate effect on patient's emotional and functional outcomes that were observed during a critical period in patients' lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Aged
  • Angina, Unstable / psychology
  • Angina, Unstable / therapy
  • Anxiety / therapy
  • Chronic Disease / psychology*
  • Chronic Disease / therapy*
  • Counseling / methods*
  • Depression / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / psychology
  • Myocardial Infarction / therapy
  • Myocardial Ischemia / psychology*
  • Myocardial Ischemia / therapy*
  • Prospective Studies
  • Recovery of Function
  • Telephone