Study of Heart Disease Patients Treated for Depression
and Low Social Support Finds No Survival Benefit but Significant
Improvement in Depression and Social Functioning
The first major study to evaluate the effects of treating
depression and low social support in recent heart attack patients
found no reduction in deaths or second heart attacks; however, study
participants showed significant improvement in depression and social
functioning.
Results from the Enhancing Recovery in Coronary Heart Disease Patients
Study (ENRICHD), which was supported by the National Heart, Lung,
and Blood Institute (NHLBI), are published in the June 18 “theme
depression issue” of the Journal of the American Medical Association
(JAMA). Susan Czajkowski, Ph.D., ENRICHD project officer and an
NHLBI research psychologist, will discuss the results at a June
17 JAMA press briefing at the National Press Club in Washington,
D.C.
Social isolation and depression are risk factors for death and
recurrent heart attack in heart disease patients. About 25 percent
of heart disease patients have one of these conditions after a heart
attack, a situation that places them at a 3-to-4 times higher risk
of death.
ENRICHD enrolled 2, 481 patients within 28 days of a heart attack.
Patients had depression, low social support, or both. After random
assignment to a “treatment” or “usual medical
care” group, all patients received written information on
heart disease risk factors. The “treatment” group also
received 6 months of cognitive behavioral therapy. During these
sessions, trained counselors provided cognitive therapy, which seeks
to modify or eliminate thought patterns contributing to the patient’s
symptoms, and behavioral therapy which helps patients change habits.
Some patients received antidepressants.
Survival at 29 months was virtually identical in both groups –
75.9 percent in usual care and 75.8 percent in the treatment group.
The risk of death or of a second heart attack was lower among patients
who were taking antidepressants, regardless of whether they received
counseling. However, this finding is not definitive because the
study was not specifically designed to test the effects of antidepressants.
Future studies will be needed to address this question.
ENRICHD’s depression/social support findings reveal the benefits
of treatment on quality of life. At 6 months, depressed patients
in the treatment group had a 57 percent reduction in depression
versus a 47 percent reduction in the usual care group. Patients
with low social support in the treatment group had a 27 percent
improvement in this condition compared to an 18 percent improvement
in usual medical care.
According to Czajkowski, these findings show that treatment can
have a significant impact on heart attack patients’ psychosocial
functioning. She adds that the ENRICHD results offer an important
public health message: Heart attack patients who show signs of depression
should be evaluated and treated according to existing guidelines.
At present, only an estimated 25 percent of heart attack patients
with depression are being treated for this condition.
The following ENRICHD investigators are available for interviews:
- Dr. Czajkowski. For interviews, contact the NHLBI Communications
Office at 301-496-4236.
- Lisa Berkman, Ph.D., ENRICHD study chair and professor
at the Harvard School of Public Health, Boston, MA. For an interview,
contact Kevin Myron at
617-432-3952
- Allan S. Jaffe, M.D., ENRICHD study co-chair and cardiologist
and professor of medicine at the Mayo Clinic, Rochester, MD. For
an interview, contact Dr. Jaffe at 507-284-4278.
- Robert M. Carney, Ph.D., ENRICHD investigator and professor
of psychiatry at Washington University in St. Louis, MO. For an
interview, contact Dr. Carney at 314-286-1300.
NHLBI is part of the National Institutes of
Health, the Federal Government’s primary agency for biomedical
and behavioral research. NIH is a component of the U.S. Department
of Health and Human Services. NHLBI press releases and other materials
are available online at http://www.nhlbi.nih.gov.
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