title: Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  Optimism has been associated with a lower risk of rehospitalization after coronary artery bypass graft (CABG) surgery, but little is known about how optimism affects treatment of depression in post-CABG patients.
  
  
  METHODS
  Using data from a collaborative care intervention trial for post-CABG depression, we conducted exploratory post hoc analyses of 284 depressed post-CABG patients (2-week posthospitalization score in the 9-item Patient Health Questionnaire ≥ 10) and 146 controls without depression who completed the Life Orientation Test - Revised (full scale and subscale) to assess dispositional optimism. We classified patients as optimists and pessimists based on the sample-specific Life Orientation Test - Revised distributions in each cohort (full sample, depressed, nondepressed). For 8 months, we assessed health-related quality of life (using the 36-item Short-Form Health Survey) and mood symptoms (using the Hamilton Rating Scale for Depression [HRS-D]) and adjudicated all-cause rehospitalization. We defined treatment response as a 50% or higher decline in HRS-D score from baseline.
  
  
  RESULTS
  Compared with pessimists, optimists had lower baseline mean HRS-D scores (8 versus 15, p = .001). Among depressed patients, optimists were more likely to respond to treatment at 8 months (58% versus 27%, odds ratio = 3.02, 95% confidence interval = 1.28-7.13, p = .01), a finding that was not sustained in the intervention group. The optimism subscale, but not the pessimism subscale, predicted treatment response. By 8 months, optimists were less likely to be rehospitalized (odds ratio = 0.54, 95% confidence interval = 0.32-0.93, p = .03).
  
  
  CONCLUSIONS
  Among depressed post-CABG patients, optimists responded to depression treatment at higher rates. Independent of depression, optimists were less likely to be rehospitalized by 8 months after CABG. Further research should explore the impact of optimism on these and other important long-term post-CABG outcomes.
authors.affiliation: Department of Medicine, University of Pittsburgh, 230 McKee Pl, Suite 600, Pittsburgh, PA 15213, USA. tindleha@upmc.edu
authors.forename: Hilary
authors.initials: H
authors.lastname: Tindle
authors.forename: Bea Herbeck
authors.initials: BH
authors.lastname: Belnap
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Michael F
authors.initials: MF
authors.lastname: Scheier
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Fanyin
authors.initials: F
authors.lastname: He
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
mesh_terms: D000223:Adaptation, Psychological; D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D001026:Coronary Artery Bypass / Q000523:psychology* / Q000534:rehabilitation; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D017216:Telemedicine; D013694:Temperament; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents