Background Despite high rates of post-cardiac surgery depression, studies of depression treatment in this population have been limited. Objective To evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. Methods From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and one month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV (SCID-I); those who met criteria for clinical depression (n=81) were randomized to CBT (n=45) or usual care (UC; n=36). After completion of the UC period, 25 individuals were offered later CBT (UC+CBT). Results Main outcomes (depressive symptoms [BDI] and clinical depression [SCID-I]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. In the CBT group compared to the UC group, there was greater decline in BDI scores (β=1.41 [95% CI 0.81–2.02], p = <.001) and greater remission of clinical depression (29 [64%] vs. 9 [25%], number need to treat, 2.5 [95% CI, 1.7–4.9], p < .001). Compared to the early CBT group, (median time from surgery to CBT = 45.5 days) the later UC+CBT group (median time from surgery to CBT = 122 days) also experienced a reduction in BDI scores, but the group x time effect was smaller (β=0.79 [95% CI 0.101.47], p = .03) and remission rates between the two groups did not differ. Conclusions Early home CBT is effective in depressed post-cardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.
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