Effects of a stress management program on vital exhaustion and depression in women with coronary heart disease: a randomized controlled intervention study

• Published in: Journal of internal medicine Vol. 263; no. 3; pp. 281 - 293
• Main Authors: Koertge, J., Janszky, I., Sundin, Ö., Blom, M., Georgiades, A., László, K. D., Alinaghizadeh, H., Ahnve, S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-03-2008; Blackwell Science
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Biological and medical sciences; CHD; Cognitive Therapy - methods; Coronary Disease - psychology; Coronary Disease - therapy; Depression; Depressive Disorder - etiology; Depressive Disorder - prevention & control; depressive symptoms; Fatigue - etiology; Fatigue - prevention & control; Female; Follow-Up Studies; General aspects; Humans; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mood disorders; Myocardial Revascularization; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; RCT; Sex Factors; stress management; Stress, Psychological - etiology; Stress, Psychological - prevention & control; vital exhaustion; women; Human; Mood disorder; RCT; Program; Cardiovascular disease; Depression; vital exhaustion; Coronary heart disease; depressive symptoms; Stress; Medicine; Randomization; Clinical management; Adult; Clinical trial; Female; Woman; stress management; CHD; women
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1111/j.1365-2796.2007.01887.x

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Objectives.  Psychosocial factors, including depression and vital exhaustion (VE) are associated with adverse outcome in coronary heart disease (CHD). Women with CHD are poor responders to psychosocial treatment and knowledge regarding which treatment modality works in them is limited. This randomized controlled clinical study evaluated the effect of a 1‐year stress management program, aimed at reducing symptoms of depression and VE in CHD women.
Design.  Patients were 247 women, ≤75 years, recruited consecutively after a cardiac event and randomly assigned to either stress management (20 2‐h sessions) and medical care by a cardiologist, or to obtaining usual health care as controls. Measurements at; baseline (6–8 weeks after randomization), 10 weeks (after 10 intervention sessions), 1 year (end of intervention) and 1–2 years follow‐up.
Results.  For VE, intention to treat analysis showed effects for time (P < 0.001) and time × treatment interaction (P = 0.005), reflecting that both groups improved over time, and that the decrease of VE was more pronounced in the intervention group. However, the level of VE was higher in the intervention group than amongst controls at baseline, 22.7 vs. 19.4 (P = 0.036) but it did not differ later. The change in depressive symptoms did not differ between the groups.
Conclusions.  CHD women attending our program experienced a more pronounced decrease in VE than controls. However, as they had higher baseline levels, due to regression towards the mean we cannot attribute the decrease in VE to the intervention. Whether the program has long‐term beneficial effects needs to be evaluated.