June 18, 2003JAMA
Effects of Treating Depression and Low Perceived Social Support on Clinical Events After Myocardial Infarction
Key result
Cognitive behavior therapy supplemented with SSRIs did not significantly improve event-free survival for death or recurrent MI compared to usual care (75.8% vs 75.9%).
Why the study?
Does cognitive behavior therapy supplemented with SSRIs reduce death or recurrent MI in patients with depression or low perceived social support after a recent myocardial infarction?
Population
2481 patients enrolled within 28 days after myocardial infarction, diagnosed with major or minor depression…
Comparison
Cognitive behavior therapy initiated at a median… vs Usual medical care.
Design
RCT, Random allocation
Follow-up
average 29 months
Authors
Discussion
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Implication
Psychosocial intervention improves depression and support without reducing death or recurrent MI; challenges assumptions that treating these factors improves post-MI survival.
Study Design
Type
RCT (n=2,481)
Randomization
Random allocation
Multicenter
Yes
Structured PICO
Does cognitive behavior therapy supplemented with SSRIs reduce death or recurrent MI in patients with depression or low perceived social support after a recent myocardial infarction?
P
Population
2,481 patients with depression or low perceived social support enrolled within 28 days after myocardial infarction, followed for an average of 29 months.
I
Intervention
Cognitive behavior therapy (CBT) initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, supplemented with a selective serotonin reuptake inhibitor (SSRI) for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks.
C
Comparator
Usual medical care.
O
Outcome
Composite primary end point of death or recurrent MI.composite
Main Result
Absolute Event Rate: 75.8% vs 75.9%
p-value: p=not significant
Treating depression and low perceived social support with CBT and SSRIs after a myocardial infarction improves psychosocial outcomes but does not significantly reduce the risk of death or recurrent MI.
Limitations
- Relative improvement in the psychosocial intervention group was less than expected due to substantial improvement in usual care patients.
- Relative improvement in the psychosocial intervention group was less than expected due to substantial improvement in usual care patients
Cite This Study
Berkman et al. (2003) conducted an RCT in Myocardial infarction with depression or low perceived social support (n=2,481). Cognitive behavior therapy (CBT) supplemented with SSRIs vs. Usual medical care was evaluated on Composite of death or recurrent MI (reported as event-free survival) (p=not significant). Cognitive behavior therapy supplemented with SSRIs did not significantly improve event-free survival for death or recurrent MI compared to usual care (75.8% vs 75.9%).