Abstract 16947: Improving Depressive Symptoms among Rural Patients at High Risk for Cardiovascular Disease in the Most Mentally Distressed Area in the Country
Background: Appalachian Kentucky has the highest rate of mentally unhealthy days in the country. Depressive symptoms are associated with high cardiovascular disease (CVD) risk, and adults with depressive symptoms in this area are more likely to have multiple CVD risk factors and engage in non-heart healthy behaviors than non-depressed adults. Objective: To determine the impact of a self-care CVD risk reduction intervention for rural Appalachians at high risk for CVD that included depression reduction and prevention.
Methods: We enrolled 425 adults (76% women; mean age 58 ± 16yrs) living in rural Appalachia with two or more CVD risk factors and randomized them to an immediate intervention group or a wait-list control group in which the intervention was delayed 3 months. The intervention had 12-weekly sessions on self-care and CVD risk reduction, focused on addressing environmental and individual barriers to risk reduction, along with depression self-care strategies. The program focused on lifestyle change and behavioral interventions and did not include medical therapy. Depressive symptoms were measured by the Patient Health Questionnaire-9.
Results: Depression scores increased during the 3 month non-intervention period in the wait-list control group and decreased significantly in both groups (p < 0.001) from pre- to post-intervention (figure). A total of 18.5% of participants had depressive symptoms prior to the intervention. After the intervention, 7.6% of participants had scores placing them in that category, a 41% reduction in depression.
Conclusion: A self-care approach to depression management is effective in a rural population living in a socioeconomically austere area at high risk for both depression and CVD.
- © 2013 by American Heart Association, Inc.