Abstract 9597: Benefits of Nurse-Guided Cognitive Behavioral Therapy for Depression after Cardiac Surgery

Abstract

Background: Depression occurs in 15 to 40% of patients undergoing cardiac surgery, but studies of depression treatment after cardiac surgery have been limited. Objective: To evaluate nurse-guided cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. Methods: We enrolled 808 cardiac surgery patients from five hospitals. They were screened for depressive symptoms with the Beck Depression Inventory (BDI) in the hospital and one month later and interviewed using the Structured Clinical Interview for DSM-IV (SCID-I); those who met criteria for clinical depression (n=81; 31% female, age 63 ± 9.8 years) were randomized to CBT (n=46) or usual care (UC; n=35). CBT patients received 8 weeks of nurse-guided therapy. UC patients received usual postop care plus biweekly phone calls to maintain contact. After 8 weeks, clinical depression in both groups was re-evaluated. Differences in symptom severity and depression status were determined by McNair-Bowker and Chi-Square tests, respectively. Clinical importance of change in BDI scores was evaluated by the Reliable Change Index method of Jacobson and Traux. Results: Intention-to-treat analyses showed greater reduction on the BDI in the CBT group compared to the UC group (mean BDI 9.7 [95% CI, 6.9-12.5] vs 17.6 [95% CI, 14.5-20.6], F=14.7, p<.0001). CBT patients showed greater reduction in symptom severity than did UC patients (Figure). The CBT group was more likely to report remission in clinical depression (63% vs 23%; number need to treat, 2.5 [95% CI, 1.7-4.9]) than the UC group (p<.0001). CBT reduced sleep disturbance (p = .01) and pain interference (, p=.001) and increased perceived control (p = .008). Conclusions: Nurse-guided CBT is an effective treatment option for depressed patients after cardiac surgery. Nurse-guided CBT also reduced negative aspects of other common postop complaints and increased patients' sense of control over their cardiac disease.