Enhancing Recovery in Coronary Heart Disease (ENRICHD) study intervention: rationale and design.
OBJECTIVE
Depression and low social support are risk factors for medical morbidity and mortality after acute MI. The ENRICHD study is a multicenter, randomized, controlled clinical trial of a cognitive-behavioral treatment for depression and low social support in post-MI patients. A total of 2481 patients were recruited (26% with low social support, 39% with depression, and 34% with low social support and depression). Our objective is to describe the rationale, design, and delivery of the ENRICHD intervention.


METHODS
Key features of the intervention include the integration of cognitive-behavioral and social learning approaches to the treatment of depression and a diverse set of problems that can contribute to low social support; rapid initiation of treatment after MI; a combination of individual and group modalities; adjunctive pharmacotherapy for severe or intractable depression; training, certification, and supervision of therapists; and quality assurance procedures.


RESULTS
The trial's psychosocial and medical outcomes will be presented in future reports.


CONCLUSIONS
The ENRICHD protocol targets two complex psychosocial risk factors with a multifaceted intervention, which is delivered in an individualized manner to accommodate a demographically, medically, and psychiatrically diverse patient population. Additional research will be needed to identify optimal matches between patient characteristics and specific components of the intervention.
D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003327:Coronary Disease / Q000534:rehabilitation; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011615:Psychotherapy, Group; D012107:Research Design; D012944:Social Support; D014481:United States