Psychosocial interventions for patients after a cardiac event

Abstract

A large body of evidence links depression and coronary artery disease and includes findings that patients who experience depression at the time of an acute cardiac event die sooner than their nondepressed counterparts. Although cardiac rehabilitation programs addressing medical, lifestyle, and psychosocial issues have positive effects on behavioral change, significantly reduce the risk of having future cardiac events, and reduce mortality, depressed mood and social isolation can compromise the positive effects of these programs. Systematic reviews have shown the effectiveness of psychological interventions for cardiac patients; however, comparison of interventions is difficult due to variation in target population, severity of depression, “dose” and mode of delivery of the intervention delivered, variation in outcome measures used, varied follow-up periods, and lack of detail on intervention content. Brief interventions have been shown to be effective in reducing depression, as has Internet-delivered cognitive-behavioral therapy for adults with high CVD risk. Interventions comprising psychological and social support-enhancing components, when compared with usual care, are also effective in reducing depressive symptoms in cardiac patients. Although effect sizes reflect a small benefit of these psychosocial interventions, it appears that they improve social support and possibly mental health quality of life, but no firm conclusions can be drawn as to whether these interventions impact on cardiac mortality and morbidity. Notwithstanding methodological limitations and the modest effects achieved, psychological and psychosocial interventions are worth implementing, post-cardiac event, as unresolved depression is a major cause of death and disability in cardiac patients.