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Effect of depression treatment on health behaviors and cardiovascular risk factors in primary care patients with depression and elevated cardiovascular risk: data from the eIMPACT trial

Published online by Cambridge University Press:  10 September 2024

Matthew D. Schuiling Open the ORCID record for Matthew D. Schuiling [Opens in a new window] ,
Aubrey L. Shell Open the ORCID record for Aubrey L. Shell [Opens in a new window] ,
Christopher M. Callahan ,
John I. Nurnberger Jr. ,
Krysha L. MacDonald Open the ORCID record for Krysha L. MacDonald [Opens in a new window] ,
Robert V. Considine ,
Wei Wu ,
Adam T. Hirsh Open the ORCID record for Adam T. Hirsh [Opens in a new window] ,
Christopher A. Crawford  and
Michelle K. Williams
...Show all authors
Matthew D. Schuiling
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Aubrey L. Shell
Affiliation:
Ball Memorial Outpatient Behavioral Health, Indiana University Health, Muncie, IN, USA
Christopher M. Callahan
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
John I. Nurnberger Jr.
Affiliation:
Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
Krysha L. MacDonald
Affiliation:
Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
Robert V. Considine
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Wei Wu
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Adam T. Hirsh
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Christopher A. Crawford
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Michelle K. Williams
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Timothy C. Lipuma
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
Samir K. Gupta
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Richard J. Kovacs
Affiliation:
Division of Cardiovascular Disease, Indiana University School of Medicine, Indianapolis, IN, USA
Bruce L. Rollman
Affiliation:
Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Jesse C. Stewart*
Affiliation:
Department of Psychology, Indiana University Indianapolis, Indianapolis, IN, USA
*
Corresponding author: Jesse C. Stewart; Email: [email protected]
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Abstract

Background

Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.

Methods

Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.

Results

The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).

Conclusions

Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.

Trial Registration:

ClinicalTrials.gov Identifier: NCT02458690

Keywords

blood pressurecardiovascular diseaseclinical trialcollaborative caredepressioninternet interventionslipidsmedication adherencesedentary behaviorsleep quality
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 12 , September 2024 , pp. 3303 - 3316
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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