title: Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. Thomas.mclaughlin@umassmed.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McLaughlin
authors.forename: Onesky
authors.initials: O
authors.lastname: Aupont
authors.forename: Kara Z
authors.initials: KZ
authors.lastname: Bambauer
authors.forename: Peter
authors.initials: P
authors.lastname: Stone
authors.forename: Mariquita G
authors.initials: MG
authors.lastname: Mullan
authors.forename: Jane
authors.initials: J
authors.lastname: Colagiovanni
authors.forename: Elaine
authors.initials: E
authors.lastname: Polishuk
authors.forename: Michael
authors.initials: M
authors.lastname: Johnstone
authors.forename: Steven E
authors.initials: SE
authors.lastname: Locke
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000789:Angina, Unstable / Q000523:psychology / Q000628:therapy; D001007:Anxiety / Q000628:therapy; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy*; D003376:Counseling / Q000379:methods*; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology / Q000628:therapy; D017202:Myocardial Ischemia / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D020127:Recovery of Function; D013689:Telephone