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An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial
Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.ORCID iD: 0000-0001-7431-2873
Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-4753-6745
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
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2019 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 6, no 10, article id e14648Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression.

OBJECTIVE: The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD.

METHODS: A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire-9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale-self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models.

RESULTS: Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=-2.34 [95% CI -3.58 to -1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression.

CONCLUSIONS: Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc. , 2019. Vol. 6, no 10, article id e14648
Keywords [en]
cardiovascular disease, cognitive behavior therapy, depression, internet, randomized controlled trial
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-161243DOI: 10.2196/14648ISI: 000489649600001PubMedID: 31584000Scopus ID: 2-s2.0-85073221407OAI: oai:DiVA.org:liu-161243DiVA, id: diva2:1365305
Note

Funding agencies: Swedish Research CouncilSwedish Research Council [2015-02600]; ALF grant Region Ostergotland [LIO-600321, LIO-687531]; ALF grant Region Ostergotland, Strategic fund [LIO-719561]

Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-12-09Bibliographically approved

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Johansson, PeterWestas, MatsAndersson, GerhardAlehagen, UrbanJaarsma, TinyMourad, GhassanLundgren, Johan

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Division of Nursing ScienceFaculty of Medicine and Health SciencesDepartment of Internal Medicine in NorrköpingPsychologyFaculty of Arts and SciencesDivision of Cardiovascular MedicineDepartment of Cardiology in Linköping
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