Congestive heart failure (CHF) is a growing major public health problem. Approximately 4 to 5 million Americans are believed to have symptomatic CHF with about 15 million individuals affected globally. Psychosocially, these patients experience significant symptoms and symptom burden and demonstrate greater impairment in health-related quality of life than other medical patient groups. In addition, depression is common among CHF patients, where estimates of the prevalence of major depressive disorder range from 24% to 42%. The impact of being both depressed and diagnosed with CHF can literally be lethal. Not only does depression impact negatively on a CHF patient's quality of life, but is associated with increased mortality. At present, there is a total lack of randomised controlled trials of psychological interventions for depressed CHF patients. As such, this project aims to address this gap, in part, by developing a psychosocial intervention protocol to treat depression among this population as adapted from a Problem-Solving Therapy (PST) model. PST is viewed as providing patients with effective skills to cope with stressful problems engendered by the disease itself (e.g., fatigue, diminished social relationships, reduced mobility), as well as with challenges related to adhering to medical treatment recommendations (e.g., increase exercise, take medication). In terms of a research agenda, it is argued that a given treatment needs to be clinically relevant specific to the population of interest prior to being subject to a large-scale evaluation. Therefore, consistent with an R34 mechanism (i.e., treatment development), this project will involve the following three stages: (a) collect data regarding CHF-related problems and problem-solving deficits in order to better adapt PST to be clinically relevant for depressed CHF patients; (b) standardize the PST intervention by developing a treatment manual for CHF patients, related evaluation tools (e.g., patient acceptance of PST protocol, patient homework compliance, treatment fidelity), and provider training procedures; and (c) test the feasibility, safety, acceptability, and potential efficacy of the PST intervention by conducting a small scale randomized clinical trial (RCT; i.e., PST versus """"""""treatment-as-usual"""""""") of depressed CHF patients regarding measures of depression, adherence, quality of life, and CHF-related functional status. This pilot project is viewed as laying the necessary groundwork for determining the soundness of conducting a larger RCT in the future to determine the impact of PST on depression and health-related outcomes. For patients with congestive heart failure, also being depressed increases the chances of diminished quality of life and reduced survival. Treating depression among such individuals, then, can potentially not only improve their mental health, but possibly their physical well being as well. ? ? ?
| Nezu, Arthur M; Nezu, Christine Maguth; Jain, Diwakar (2008) Social problem solving as a mediator of the stress-pain relationship among individuals with noncardiac chest pain. Health Psychol 27:829-32 |
