Peter Johansson1, Tiny Jaarsma2, Gerhard Andersson3, Johan Lundgren2. 1. Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden. Electronic address: peter.b.johansson@liu.se. 2. Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden. 3. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND:Patients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. OBJECTIVES: To investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DESIGN: A secondary analysis of data collected in a pilot randomized controlled study. SETTING:50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden. METHODS: Patients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-careBehaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. RESULTS: No significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-careBehaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). CONCLUSION: Improvement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.
RCT Entities:
BACKGROUND:Patients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour. OBJECTIVES: To investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failurepatients, and to study the association between changes in depressive symptoms and changes in self-care behaviour. DESIGN: A secondary analysis of data collected in a pilot randomized controlled study. SETTING: 50 heart failurepatients with depressive symptoms were recruited from four hospitals in Sweden. METHODS:Patients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups. RESULTS: No significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03). CONCLUSION: Improvement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.
Authors: Barbara Riegel; Maddalena De Maria; Claudio Barbaranelli; Maria Matarese; Davide Ausili; Anna Stromberg; Ercole Vellone; Tiny Jaarsma Journal: Front Public Health Date: 2022-05-17
Authors: Amika Shah; Neesha Hussain-Shamsy; Gillian Strudwick; Sanjeev Sockalingam; Robert P Nolan; Emily Seto Journal: J Med Internet Res Date: 2022-09-26 Impact factor: 7.076