Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients.
BACKGROUND
Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation.


METHODS
ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 +/- 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group x Time effects,chi(2)for percentage with clinically significant anxiety and depression at each time point, and logistic regression.


RESULTS
All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P < 0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups.


CONCLUSIONS
A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30022, USA. Sbdunba@emory.edu
Sandra B
SB
Dunbar
Jonathan J
JJ
Langberg
Carolyn M
CM
Reilly
Bindu
B
Viswanathan
Frances
F
McCarty
Steven D
SD
Culler
Marian C
MC
O'Brien
William S
WS
Weintraub
D001007:Anxiety / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000523:psychology / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006295:Health Resources; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D015995:Prevalence; D015397:Program Evaluation; D011613:Psychotherapy / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care; D016896:Treatment Outcome