Accepted for/Published in: JMIR Mental Health
Date Submitted: May 15, 2019
Open Peer Review Period: May 19, 2019 - Jun 24, 2019
Date Accepted: Jul 27, 2019
(closed for review but you can still tweet)
Internet-based cognitive behavioural therapy programme tailored to patients with cardiovascular disease and depression: a randomised controlled trial
ABSTRACT
Background:
Depression is a common cause of poorer wellbeing and prognosis in patients with cardiovascular disease (CVD). Yet there is a lack of effective intervention strategies targeting depression.
Objective:
To evaluate the effect of a nurse-delivered and tailored internet-based cognitive behavioural therapy (iCBT) programme aimed at reducing depression in patients with CVD.
Methods:
A randomised controlled trial. 144 CVD patients with at least mild depression (Patient Health Questionnaire-9 (PHQ-9) score ≥ 5) were randomised 1.1 to nine-week iCBT (n=72) or an active control participating in a Web-based discussion forum (ODF, n=72). The iCBT programme was adapted to fit patients with CVD. Feedback was provided by nurses with experience of CVD and a short introduction in CBT. The primary outcome, depression, was measured by the PHQ-9. Secondary outcomes were depression measured with Montgomery Åsberg Depression Rating Scale-self rating Scale (MADRS-S), Health-related Quality of life measured with Short Form 12 (SF-12) and EQ-VAS and adherence. Intention-to-treat analysis with multiple imputations was used. Between group differences of the primary and secondary outcomes was determined by analysis of covariance and sensitivity analysis was performed with mixed models.
Results:
iCBT had compared to ODF a significant and moderate treatment effect on the primary outcome depression (i.e. PHQ-9) (mean group difference -2.34 [95 % CI -3.58 to -1.10], P <0.001., Cohens d=0.62). In the secondary outcomes iCBT compared to ODF had a significant and large effect on depression (i.e. MADRS-S) (P<.001, Cohens d=0.86) and a significant and moderate effects on the mental component scale of the SF-12 (P<.001., Cohens d=0.66) and the EQ-VAS (P<.001., Cohens d=0.62). A total of 60% (n=43) in the iCBT group completed all seven modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study due to high risk of suicide or deterioration in depression.
Conclusions:
Nurse-delivered iCBT can reduce depression and improve HRQoL in CVD patients enabling treatment for depression in their own homes and at their own preferences of time. Clinical Trial: ClinicalTrials.gov, NCT02778074
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