Improving psychologic adjustment to chronic illness in cardiac patients
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
BACKGROUND: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function.
OBJECTIVE: To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness.
DESIGN: Randomized, controlled trial.
METHODS: We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients’ responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes.
RESULTS: We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function.
CONCLUSIONS: The intervention had a moderate effect on patient’s emotional and functional outcomes that were observed during a critical period in patients’ lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.
- McGovern PG, Pankow JS, Shahar E, et al. Recent trends in acute coronary heart disease: mortality, morbidity, medical care, and risk factors. N Engl J Med. 1996;334:884–90. CrossRef
- Lenexa RD, Scott-Lenexa JA, Bohlig EM. The cost of depression-complicated alcoholism: health-care utilization and treatment effectiveness. J Ment Health Adm. 1993;20(Summer):138–52. CrossRef
- Reisner C, Gondek K, Musheno M, Menioge S, Mandel M. Depression severity and smoking history, but not age or fev1, highly correlate with total charges and medical resource utilization in chronic obstructive pulmonary disease. ACCP Annual Meeting Chest. 1998;114(suppl 4):341S. (abstract).
- Friedman R, Sobel D, Meyers P, Caudillo M, Benson H. Behavioral medicine, clinical health psychology, and cost offset. Health Psychol. 1995;14:509–18. CrossRef
- Clark NM, Becker MH. Theoretical Models and Strategies for Improving Adherence and Disease Management. Handbook of Health Behavior Change. New York: Springer Verlag; 1998.
- Koocher GP, McGrath ML, Gudas LJ. Typologies of non-adherence in cystic fibrosis. J Dev Behav Pediatrics. 1990;11:353–8.
- Turk DC, Kerns RD. Health, Illness and Families: A Life-Span Perspective. New York: Wiley-Interscience; 1985.
- Frasure-Smith N, Lespérance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival. JAMA. 1993;270:1819–25. CrossRef
- Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001;88:337–41. CrossRef
- Carney RM, Rich MW, TeVelde A, Saini J, Clark K, Jaffe AS. Major depressive disorder in coronary artery disease. Am J Cardiol. 1987;60:1273–5. CrossRef
- Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease. Depress Anxiety. 1998;8(suppl 1):71–9. CrossRef
- Patten SB. Long-term medical conditions and major depression conditions in the Canadian population. Canad J Psychiatry. 1999;4:151–7.
- Kubzansky LD, Davidson KW, Rozanski A. The clinical impact of negative psychological states: expanding the spectrum of coronary artery disease. Psychosomatic Medicine. 2005;67(suppl 1):S10–4. CrossRef
- Writing Committee for the ENRICHD Investigators. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA. 2003;289:3106–1. CrossRef
- Berkman LF, Jaffe AS, for the ENRICHD Investigators. The effects of treating depression and low social support on clinical events after a myocardial infarction. Circulation. 2001;104:2.
- Glassman AH, O’Connor CM, Califf RM, Swedberg K, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288:701–9. CrossRef
- Royal College of Physicians. The Psychological Care of Medical Patients: Recognition of Need and Service Provision, Joint Working Party Report of the Royal College of Physicians of London and Psychiatrists. London, UK, Royal College of Physicians, July 1994.
- Bronheim HE, Fulop G, Kunkel EI, et al. The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. Psychosomatics. 1998;39:S8–30.
- Pollin I. Medical Crisis Counseling: Short Term Therapy for Long Term Illness. New York: W.W. Norton & Company; 1995.
- Koocher GP, Curtis EK, Patton KE, et al. Medical crisis counseling in a health maintenance organization. Prof Psychol: Res Practice. 2001;32:52–8. CrossRef
- Haley J. Problem-Solving Therapy. San Francisco: Jossey-Bass; 1987.
- Simon G, VonKroff M, Rutter C, et al. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ. 2002;320:550–4. CrossRef
- Hunkeler E, Meresman J, Hargreaves W, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Family Med. 2000;9:700–8. CrossRef
- Simon GE, Ludman P, Tutty S, et al. Telephone psychotherapy and telephone care management for primary care patients starting anti-depressant treatment: a randomized controlled trial. JAMA. 2004;292:935–42. CrossRef
- Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Psychiatr Scand. 1983;67:361–70.
- Stoudemire A. Depression in the medically ill. In: Michels R, et al., ed. Psychiatry, Vol. 2. Philadelphia: JB Lippincott Company; 1991:1–12.
- Mundt JC, Marks IM, Shear MK, Greist JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180:461–4. CrossRef
- Spitzer R, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 Study. JAMA. 1994;272:1749–56. CrossRef
- Johnston M, Foulkes J, Johnston DW, Pollard B, Gudmundsdottir H. Impact on patients and partners of inpatient and extended cardiac counseling and rehabilitation: a controlled trial. Psychosom Med. 1999;61:225–33.
- Frasure-Smith N, Lesperance F, Talajic M. Coronary heart disease/myocardial infarction: depression and 18-month prognosis after myocardial infarction. Circulation. 1995;91:999–1005.
- Lesperance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med. 1996;58:99–110.
- Improving psychologic adjustment to chronic illness in cardiac patients
Journal of General Internal Medicine
Volume 20, Issue 12 , pp 1084-1090
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- chronic medical illness
- psychological adjustment
- Industry Sectors
- Author Affiliations
- 1. Departments of Pediatrics and Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, 01655, Worcester, MA
- 2. Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass, USA
- 3. Brigham and Women’s Hospital, Boston, Mass, USA
- 4. Beth Israel Deaconess Medical Center, Boston, Mass, USA