Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients

Sandra B. Dunbar, Jonathan J. Langberg, Carolyn M. Reilly, Bindu Viswanathan, Frances McCarty, Steven D. Culler, Marian C. O'Brien, William S. Weintraub

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    Abstract

    Background: Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation. Methods: ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 ± 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group × Time effects, χ 2 for percentage with clinically significant anxiety and depression at each time point, and logistic regression. Results: All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P <0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups. Conclusions: A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant. (PACE 2009; 1259-1271). © 2009 Wiley Periodicals, Inc.
    Original languageEnglish
    Pages (from-to)1259-1271
    Number of pages12
    JournalPACE - Pacing and Clinical Electrophysiology
    Volume32
    Issue number10
    DOIs
    Publication statusPublished - Oct 2009

    Keywords

    • Defibrillation - ICD
    • Quality of life
    • Ventricular tachycardia

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