This study aims to develop an intervention to treat depression in patients with congestive heart failure by addressing the emotional and behavioral sequelae of functional decline. Heart failure affects 4 to 5 million Americans and is the number one cause of hospitalization in people aged 65 and older, it leads to marked functional impairment and poor quality of life. People with heart failure also suffer significant depressive morbidity, with an estimated 11 to 36% meeting criteria for major or minor depression. In 1998, an estimated $5 billion of the $20 billion total cost for heart failure was associated with psychological distress and depression. ? The proposed treatment development entails integration of interpersonal psychotherapy (IPT) and behavioral activation (BA) techniques to reduce depression and improve functioning. Since many patients with advanced heart failure are homebound, we aim to develop the treatment so that it can be administered primarily by telephone. Access to care has been a major barrier to treatment in prior psychosocial studies in cardiac patients, particularly in rural settings. A manualized protocol developed specifically for telephone administration will greatly enhance actual dissemination of the intervention. The principal investigator's prior research showed how poor adjustment to impairment predicts chronicity of depressive symptoms even after controlling for baseline severity of depression. These factors represent a failure to accept functional loss and to develop new roles and activities consistent with the patient's current impaired functioning. IPT techniques will address issues of grief and loss and will help facilitate role transitions related to functional decline. BA techniques will be harnessed to increase engagement in meaningful activities and social interactions. The intervention targets depressive symptoms but also aims to improve role functioning and engagement in personal relationships. We will also examine whether reduction in depression corresponds to improved management of heart failure. ? Treatment development will include two phases. Phase I will entail a standardization of treatment based on pilot data with 15 heart failure patients. The main product of this phase will be a preliminary treatment manual. Phase II will include a pilot randomized clinical trial including 36 patients receiving the intervention and 36 patients in an attention control group. The main products of this phase are a finalized treatment manual and an estimate of treatment effect size. Treatment development will also determine optimal feasibility and recruitment strategies to yield adequate samples for a full-scale clinical trial. ? This study aims to develop an effective psychotherapy to treat depression in people with heart failure. Treatment development will focus on helping elders cope with functional decline. Although the focus of the treatment study is patients with heart failure, the long-term goal is to develop a treatment that reduces depression in elders suffering from irreversible loss in function. ? ? ?
| Turvey, Carolyn L; Schultz, Susan K; Beglinger, Leigh et al. (2009) A longitudinal community-based study of chronic illness, cognitive and physical function, and depression. Am J Geriatr Psychiatry 17:632-41 |
