Published in the journal Brain, Behavior and Immunity. Here is a link to the article.
Regenstrief Institute authors: Christopher M. Callahan, M.D., Sumedha Gupta, PhD, (affiliated scientist), Sujuan Gao, PhD, (affiliated scientist)
Abstract
Although depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges’ g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results – 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI: 1.93-7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers – i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges’ gs = -0.23 to 0.02, ps ≥ 0.09). Our modernized collaborative care intervention – which harnessed technology to maximize access and minimize resources – produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches. Trial Registration:ClinicalTrials.gov Identifier: NCT02458690.
Authors:
Jesse C Stewart1, Jay S Patel2, Brittanny M Polanka3, Sujuan Gao4, John I Nurnberger5, Krysha L MacDonald6, Samir K Gupta7, Robert V Considine7, Richard J Kovacs8, Elizabeth A Vrany9, Jessica Berntson10, Loretta Hsueh11, Aubrey L Shell12, Bruce L Rollman13, Christopher M Callahan14
Affiliations
1Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA. Electronic address: jstew@iupui.edu.
2Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
3Division Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA.
4Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA.
5Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
6Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN, USA.
7Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
8Division of Cardiovascular Disease, Indiana University School of Medicine, Indianapolis, IN, USA.
9Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
10Dr. Jessica Berntson Inc., Coquitlam, BC, Canada.
11Department of Psychology, University of Illinois Chicago, Chicago, IL, USA.
12Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA.
13Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
14Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA.
