Psychosocial interventions in cardiovascular disease – what are they?

Abstract

There is growing interest in psychosocial factors in the etiology and prognosis of coronary heart disease. There is also recent interest in psychosocial interventions as a means to improve outcome in this patient group, including those with chronic heart failure or referred for cardiac rehabilitation, and for their support givers. However, there is a lack of consistency in the way psychosocial interventions are defined, delivered and tested, thus complicating or rendering meaningless any evaluation of efficacy. For instance, in trials and meta-analyses the term psychosocial interventions has often not been defined at all or defined in detail, such as ‘a structured nonpharmacologic intervention conducted by health professionals that is focused on improving the psychologic and/or social aspects of a patient’s health’. Typically, the term psychosocial intervention is used when a more apt description would be behavioral, educational, psychological or social intervention. Indeed, some recent reviews of behavioral or nonpharmacological interventions have included studies that are deemed psychosocial interventions or have elements of them. In fact, the terms psychosocial and behavioral interventions are often used synonymously and many supposed psychosocial interventions tend to be a mixture of some or all of these components, e.g. psycho-educational. We suggest, however, that the term should be reserved only for interventions that combine psychological (e.g. cognitive behavioral therapy) and social (e.g. social support) components, whilst acknowledging that psychological and social benefits may accrue, for example, from the education and exercise provided in a cardiac rehabilitation program. An example of a true psychosocial intervention is the ENRICHD (Enhancing Recovery in Coronary Heart Disease) study which addressed depression and social support. To improve transparency of psychosocial interventions and enable their reproducibility, comparison and evaluation, a proposed taxonomy that cuts across four dimensions is helpful. This taxonomy examines along a continuum: