New study: Treating depression, low social supports does not reduce heart patients' deaths, heart attacks

November 28, 2001

CHAPEL HILL -- Treating depressed patients -- or those who lack the social support provided by family and friends -- with counseling and possibly psychotropic drugs soon after a heart attack apparently doesn't lower their risk of death or of having another attack.

That's the conclusion University of North Carolina at Chapel Hill scientists and colleagues have drawn after completing a first-of-its-kind study of patients with heart disease.

Treatment does benefit patients by reducing their depression and boosting their social support levels, however, according to the National Heart, Lung and Blood Institute-sponsored research.

"Our findings were a little disappointing because we hoped to have good news on this issue for patients," said Dr. Diane Catellier of the UNC School of Public Health. "Still, studies with negative findings are just as important a part of science as studies that turn out positively since they help bring us closer to the truth."

Catellier is a research assistant professor of biostatistics and principal investigator for the study's coordinating center, based at UNC's Collaborative Studies Coordinating Center. She and colleagues from across the country presented their results recently at the American Heart Association's Scientific Sessions conference in Anaheim, Calif. Dr. James D. Hosking, research associate professor of biostatistics at UNC, also was instrumental in the work.

The Enhancing Recovery in Coronary Heart Disease Patients Study (ENRICHD) was the first major effort to evaluate the effects of treating depression and low social support in heart attack patients, Catellier said.

About a quarter of such patients are either depressed or have low social supports after their attacks, she said.

Those who have either one of the risk factors face a two to four times greater risk of premature death than those who feel reasonably content and have friends and family to support their recovery.

The research involved 73 U.S. hospitals and enrolled 2,481 patients who were depressed, had low social support or both within 28 days of a heart attack. Subjects' average age was 61, 44 percent were women and 34 percent were minorities.

Half received six months of psychological counseling and behavioral therapy, while the other half got only standard medical care. All underwent screening tests to measure depression and social support, and any who remained severely depressed were prescribed antidepressants.

Both groups showed reduced depression and feelings of isolation, but the differences were too small to cut the risk of a future heart attack or death, researchers found.

After six months, depressed patients in the treatment group scored significantly better than those in the standard medical care group on a rating method known as the Hamilton depression scale, Catellier said. For the treatment group, investigators saw a 57 percent reduction in depression vs. a 47 percent reduction for the usual medical care group.

Similarly, she said, patients in the treatment group who lacked social support had a 27 percent increase on that measure based on another evaluation method known as the ENRICHD Social Support Instrument compared to an 18 percent improvement in the others.

Despite the treatment group's depression and social support improvement, essentially no change was seen in heart disease survival, Catellier said. After three years, 24 percent of the patients in both the treatment group and the usual care group had either died or suffered a second heart attack.

"This work shows we can improve heart patients' quality of life through this kind of therapy even if we can't change their clinical outcomes overall," she said. "Our next step will be to go back and do a meticulous analysis of this data to determine why the treatment didn't work or to see if certain subgroups of patients do benefit from the therapy."

"This study is an important first step in our quest to understand how to reduce heart disease risk by treating depression and social isolation," said Dr. Claude Lenfant, National Heart, Lung and Blood Institute director. "Although we did not see the hoped-for reduction in deaths and heart attacks, it is encouraging that the treated patients felt better and experienced improved social relationships."
-end-
By DAVID WILLIAMSON
UNC News Services

Note: Catellier can be reached at (919) 966-1895 or via diane_catellier@unc.edu

School of Public Health Contact: Lisa Katz, (919) 966-7467

News Services Contact: David Williamson, (919) 962-8596

University of North Carolina at Chapel Hill

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