Infection, depression, and immunity in women after coronary artery bypass: a pilot study of cognitive behavioral therapy.
BACKGROUND
Depression is common after coronary artery bypass graft (CABG) surgery, but little is known about its effect on post-CABG inflammation or infection or about the most effective treatment for post-CABG depression.


OBJECTIVE
(1) To determine ifpost-CABG depression is associated with increased infectious illness and (2) to test effects of cognitive behavioral therapy (CBT) on depressive symptoms, inflammatory biomarkers, and post-CABG infections in depressed post-CABG women.


METHODS
Randomized, controlled trial.


METHODS
Two urban tertiary care centers.


METHODS
Fifteen clinically depressed women in the first month after CABG, along with a comparison group of 37 non-depressed postCABG women, were studied. Inclusion criteria were: < or = 75 years old, English-speaking, undergoing first-time CABG, available for 6 months offollow-up, and without malignancy or autoimmune disorders.


METHODS
Eight weeks of individual home-based CBT.


METHODS
(1) Depressive symptoms measured by the Beck Depression Inventory, (2) natural killer cell cytotoxicity (NKCC) measured by 51Cr-release assay, (3) infectious illness episodes measured by the Modified Health Review, (4) interleukin (IL)-6 and C reactive protein (CRP) measured by enzyme immunoabsorbent assay.


RESULTS
Clinically depressed post-CABG women exhibited decreased NKCC and a higher incidence of in-hospital fevers and infectious illness in the first 6 months after CABG. Among depressed women, CBT yielded moderate to large effects for improved NKCC (D=0.67) and decreased IL-6 (D=0.61), CRP (D=0.85), and postoperative infectious illnesses (D=0.93). CBT holds promise for improving depression and immunity and reducing infection and inflammation after CABG.
Doering
Lynn V
LV
University of California, Los Angeles School of Nursing, USA.
Cross
Rebecca
R
Vredevoe
Donna
D
Martinez-Maza
Otoniel
O
Cowan
Marie J
MJ
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D001026:Coronary Artery Bypass / Q000523:psychology* / Q000534:rehabilitation; D003863:Depression / Q000097:blood / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012944:Social Support; D012959:Socioeconomic Factors; D013530:Surgical Wound Infection / Q000097:blood / Q000175:diagnosis*; D016896:Treatment Outcome; D014505:Urban Population; D016387:Women's Health
D015850:Interleukin-6; D002097:C-Reactive Protein