Abstract 14315: Does Gender Moderate the Effect of Virtual Cognitive Behavioral Therapy Interventions on Depressive Symptoms in Rural Cardiac Patients? Preliminary Analysis of the Combat Study

Abstract

Background: Depressive symptoms are common in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) can effectively improve depressive symptoms in patients with CHD and HF, however, traditional CBT is not accessible to most rural individuals, and some, particularly males, may be reluctant to participate in traditional CBT even if available. Therefore, we developed and tested two types of virtual CBT, video conferences with a therapist (vCBT) and self-directed CBT (iCBT). Aim: To determine whether gender moderated the effect of vcCBT or iCBT interventions on depressive symptoms in rural people with CHD and HF. Methods: This is a preliminary analysis of 4-month outcomes in an ongoing 12-month randomized comparative effectiveness trial. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). Gender was self-identified. Participants with at least mild depressive symptoms were enrolled. Participants were randomly assigned to either a 6-8 week vcCBT or iCBT without a face-to-face therapist. Repeated measures ANOVA was performed to determine whether gender interacted with either intervention to produce an effect on depressive symptoms at 4-months compared with baseline. Results: Participants (N=143) were on average 57 years old, 51% female, and 99.3 % non-Hispanic. At baseline, mean PHQ-9 score for males was 10 ± 5 and 12 ± 5 for females (p-value=0.002). Both intervention groups had a significant decrease in depressive symptoms over time (p<0.001 for group by time interaction). There was no between-group difference in improvement of depressive symptoms (p=0.415). There was no moderating interaction of gender by intervention group on depressive symptoms (p=0.502). Conclusion: Both interventions resulted in a significant decrease in depressive symptoms. The lack of a gender moderating effect demonstrates that both interventions were equally effective in males and females.