title: A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD): Results of an Observer-Blinded, Multicenter, Randomized Trial in Depressed Patients With Coronary Artery Disease.
abstract: Depression predicts adverse prognosis in patients with coronary artery disease (CAD), but previous treatment trials yielded mixed results. We tested the hypothesis that stepwise psychotherapy improves depressive symptoms more than simple information.
  
  
  
  In a multicenter trial, we randomized 570 CAD patients scoring higher than 7 on the Hospital Anxiety and Depression Scale-depression subscale to usual care plus either one information session (UC-IS) or stepwise psychotherapy (UC-PT). UC-PT patients received three individual psychotherapy sessions. Those still depressed were offered group psychotherapy (25 sessions). The primary outcome was changed in the Hospital Anxiety and Depression Scale-depression scores from baseline to 18 months. Preplanned subgroup analyses examined whether treatment responses differed by patients' sex and personality factors (Type D).
  
  
  
  The mean (standard deviation) depression scores declined from 10.4 (2.5) to 8.7 (4.1) at 18 months in UC-PT and from 10.4 (2.5) to 8.9 (3.9) in UC-IS (both p < .001). There was no significant group difference in change of depressive symptoms (group-by-time effect, p = .90). Preplanned subgroup analyses revealed no differences in treatment effects between men versus women (ptreatment-by-sex interaction = .799) but a significant treatment-by-Type D interaction on change in depressive symptoms (p = .026) with a trend for stronger improvement with UC-PT than UC-IS in Type D patients (n = 341, p = .057) and no such difference in improvement in patients without Type D (n = 227, p = .54).
  
  
  
  Stepwise psychotherapy failed to improve depressive symptoms in CAD patients more than UC-IS. The intervention might be beneficial for depressed CAD patients with Type D personality. However, this finding requires further study.
  
  
  
  www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576.
authors.affiliation: From the Department of Psychosomatic Medicine and Psychotherapy (Herrmann-Lingen, Bosbach), University of Göttingen Medical Center and German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany; Department of Psychosomatic Medicine and Psychotherapy (Beutel, Michal), University Medical Center Mainz, Mainz, Germany; Department of Psychosomatics and Psychotherapy (Deter, Weber), Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy (Fritzsche), University Medical Center Freiburg, Freiburg, Germany; Institute of Medical Statistics (Hellmich), Informatics and Epidemiology, University of Cologne, Köln, Germany; Clinic of Psychocardiology (Jordan), Kerckhoff Rehabilitation Center, Bad Nauheim, Germany; Department of General Internal and Psychosomatic Medicine (Jünger), University of Heidelberg, Heidelberg, Germany; Institute of Epidemiology (Ladwig), Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany; Department of Psychotherapy and Psychosomatics (Petrowski), Technical University of Dresden, Dresden, Germany; Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Internal Medicine and Cardiology, German Heart Cente, and German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany (Pieske); Department of Psychosomatic Medicine and Psychotherapy (Ronel), University Hospital Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy (Söllner), Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany; Clinical Trials Center (Stöhr), University of Cologne, Köln, Germany; Department of Psychosomatic Medicine and Psychotherapy (de Zwaan), Hannover Medical School, Hannover, Germany; and Department of Psychosomatics and Psychotherapy (Albus),
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.forename: Manfred E
authors.initials: ME
authors.lastname: Beutel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bosbach
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Deter
authors.forename: Kurt
authors.initials: K
authors.lastname: Fritzsche
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Jochen
authors.initials: J
authors.lastname: Jordan
authors.forename: Jana
authors.initials: J
authors.lastname: Jünger
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
authors.forename: Matthias
authors.initials: M
authors.lastname: Michal
authors.forename: Katja
authors.initials: K
authors.lastname: Petrowski
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Joram
authors.initials: J
authors.lastname: Ronel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Söllner
authors.forename: Andreas
authors.initials: A
authors.lastname: Stöhr
authors.forename: Cora
authors.initials: C
authors.lastname: Weber
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
authors.forename: Christian
authors.initials: C
authors.lastname: Albus
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000517:prevention & control*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D016037:Single-Blind Method; D064415:Type D Personality