title: An integrated secondary prevention group programme reduces depression in cardiac patients.
abstract: OBJECTIVE
  Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events. The 'Beating Heart Problems' programme was designed to support cardiac patients in behaviour change and mood management.
  
  
  METHODS
  The programme was based on cognitive behaviour therapy and motivational interviewing. A randomized controlled trial (RCT) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010. All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline (6 weeks after their acute event), and at 4- and 12-month follow up. Psychological and behavioural indicators were assessed by self-report questionnaires. Of the 275 patients enrolled into the RCT, 42 (15%) had Beck Depression Inventory-II scores >13 at baseline. Treatment and control group comparisons were undertaken for this subgroup, using growth curve modelling and testing for group differences over time in psychological, physiological, health behaviour, and self-efficacy measures.
  
  
  RESULTS
  Significantly greater improvements (p < 0.01) in depression symptoms and self-rated health were reported for the intervention group, as well as significantly larger gains in confidence in managing depression (p < 0.05) and anger (p < 0.01). Trends (0.05 < p < 0.10) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety.
  
  
  CONCLUSIONS
  A group secondary-prevention programme that integrates behavioural and mood management strategies leads to decreased depression, increased confidence, and improved health perceptions in depressed cardiac patients.
authors.affiliation: Heart Research Centre, Victoria, Australia.
authors.forename: Alyna
authors.initials: A
authors.lastname: Turner
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Murphy
authors.forename: Rosemary O
authors.initials: RO
authors.lastname: Higgins
authors.forename: Peter C
authors.initials: PC
authors.lastname: Elliott
authors.forename: Michael R
authors.initials: MR
authors.lastname: Le Grande
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Goble
authors.forename: Marian U C
authors.initials: MU
authors.lastname: Worcester
mesh_terms: D000223:Adaptation, Psychological; D000339:Affect; D000786:Anger; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D015397:Program Evaluation; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention / Q000379:methods*; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria
keywords: Cognitive behaviour therapy; coronary heart disease; depression; group therapy; motivational interviewing; secondary prevention