Abstract 2675: Effect of a Psychoeducational Intervention on Depressive Symptoms and Anxiety in ICD Patients
Objective: Clinically important levels of depression and anxiety have been reported for persons receiving implantable cardioverter defibrillators (ICD). This study tested the hypothesis that a psychoeducational intervention would reduce depressive symptoms and anxiety during the first year after ICD.
Methods: An experimental design randomized 246 ICD patients to usual care (UC) or intervention provided by group (G) or telephone (T). The intervention, provided in acute care and 2–3 months after implant, included education, symptom management training, and cognitive behavioral techniques to improve coping skills and illness appraisal. Participants were 58 ± 11 years, 73% men, 20% African American, mean LVEF of 26 ± 12%. Variables were depressive symptoms (Beck Depression Inventory; BDI-II), anxiety (State-Trait Anxiety Inventory; STAI) and functional status (Duke Activity Index; DASI) measured at baseline (BL), 3, 6 &12 M. Social support (ESSI) was measured at BL. Group X Time effects for BDI-II and STAI were analyzed with mixed models repeated-measures analyses adjusted for BL scores, gender, medications, DASI, ESSI, and comorbidities. Additionally, logistic regression determined predicted probability of depressive symptoms based on BDI-II scores controlling for BL BDI-II, gender and depression/anxiety medications.
Results: All groups decreased mean BDI-II and STAI over 12M. Both G and T had lower BDI-II and STAI scores than UC, and when controlling for covariates, a trend for group differences in STAI (p=.059) was noted at 3 months. At 12 M, the percent with depressive symptoms was 31.4% in UC vs 15.3% for the combined G & T intervention groups. Logistic regression with covariates revealed differences (p=.03) for predicted probablility (UC=.31, G=.17, T=.13) of having mild to severe depressive symptoms at 12M.
Conclusion: A psychoeducational intervention which included information, symptom management training and cognitive behavioral techniques was effective in reducing anxiety early in recovery after ICD and reduced probability of depressive symptoms at one year. These findings support both the group and cost-effective telephone intervention approaches to yield better overall psychological outcomes in high risk ICD patients.