Report addresses treatment preferences among depressed patients after heart attack

A report in the last 2011 issue of Psychotherapy and Psychosomatics addresses the treatment preferences that are expressed by depressed patients after a heart attack.

This report addresses the treatment preferences that are expressed by depressed patients after a heart attack.  Overall, an essentially equal number of patients with a prognostically significant level of post-acute coronary syndrome depression endorsed a preference for counseling and for medication. Of those who endorsed a preference for medication, over half stated that they  would utilize counseling if offered it at no cost.

In the observational Coronary Psychosocial Evaluation Study (COPES), patients at 3 northeast university hospitals were queried at the time of acute coronary syndrome (ACS) concerning their treatment preferences for emotional distress and problems coping with their ACS. Patients were ≥18 years old, spoke English or Spanish, and had scores <5 or ≥ 10 on the Beck Depression Inventory (BDI) within 1 week after the ACS. Depression diagnosis was assessed by the Depression Interview and Structured Hamilton. Only patients with a BDI score ≥ 10, that has previously been found to carry post-ACS prognostic significance, were included in the analyses. At baseline, patients were asked: (1) If your doctor advises you that you should either get counseling or take medication to help you cope, which one would you prefer? (2) Would you go to counseling, to talk about your emotions about your heart attack and coping with them, if it was offered without any costs for you? In addition, patients were questioned concerning their interest in talking about 3 common elements of the depression constellation: one's self, one's activities and one's relationships. Overall, 215 of 457 COPES patients had a BDI score ≥ 10, 143 of whom provided valid answers to the treatment preference questions. Those who did not were more likely to be Hispanic (p = 0.03), and to have major depression (p =0.02). Of respondents, 63% (n = 90) had a BDI score of 10-16, and 37% (n = 53) had a BDI score > 16; 33% (n = 47) met criteria for minor depression, and 18% (n = 26) for major depression; 55% (n = 78) were men, 14% (n = 20) Hispanic, 13% (n = 19) African American, and 78% (n = 112) Caucasian.

Fifty-two percent overall endorsed a preference for counseling; 66% with minor depression and 40% with major depression endorsed this preference (p =0.061). More men versus women endorsed a preference for medication, and women for counselingwould' or 'probably would' go to counseling if it were offered for free. More patients with minor depression versus major depression indicated a willingness to utilize counseling if offered it at no cost (p = 0.061). Of the 106 patients who had indicated a willingness to go to counseling, the vast majority indicated an interest in talking about how they feel about themselves, their recreational activities, and their relationships. Overall, an essentially equal number of patients with a prognostically significant level of post-ACS depression endorsed a preference for counseling and for medication. Of those who endorsed a preference for medication, over half stated that they would utilize counseling if offered it at no cost. The findings of this study, which are consistent with the findings of recent trials of depression treatment for medical populations, remain to be implemented and tested in large trials.