Improving psychologic adjustment to chronic illness in cardiac patients. The role of depression and anxiety.
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.
McLaughlin
Thomas J
TJ
Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. Thomas.mclaughlin@umassmed.edu
Aupont
Onesky
O
Bambauer
Kara Z
KZ
Stone
Peter
P
Mullan
Mariquita G
MG
Colagiovanni
Jane
J
Polishuk
Elaine
E
Johnstone
Michael
M
Locke
Steven E
SE
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