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APHA Scientific Session and Event Listing

Marilyn Daley, PhD¹, Donald S. Shepard, PhD¹, and Thomas J. McLaughlin, ScD². (1) Schneider Institute for Health Policy, Brandeis University, Heller School for Social Policy & Management, P.O. Box 9110, Waltham, MA 02454-9110, 781-736-3906, daley@brandeis.edu, (2) Departments of Pediatrics and Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655

A cost-effectiveness analysis was conducted of a randomized clinical trial of medical crisis counseling--a brief intervention to resolve symptoms of depression and anxiety that frequently compromise the recovery of patients experiencing a major cardiac event. Eighty patients admitted to two large Boston teaching hospitals for myocardial infarction or unstable angina over a 2 ½ year period beginning in 2001 were randomly assigned to an experimental group (n=46) that received eight telephone based counseling sessions or a control group (n=34) with usual care. The counseling sessions were based on a manual and focused on teaching patients to strengthen their existing coping mechanisms to better address their chronic illness. We obtained Hospital Anxiety and Depression scores (HADS) at baseline and at three follow-up measures (at two, three and six months post randomization). T-tests examining change scores for each patient (follow-up minus baseline values) suggest that the treatment group improved by a significantly greater amount (+3.717 points) when compared to the control group (+0.697) [p<.05]. Costs per client of the intervention were estimated at $1,550, suggesting that each one-point (or 6.5%) improvement on the HADS scale cost $570.00. Since medical crisis counseling is an effective, easily replicable intervention that can be implemented at a reasonable cost, it should be made available on a wider scale to improve health outcomes for cardiac patients.

Learning Objectives:

• Describe the relationship between major cardiac events, depression and health outcomes
• Identify an effective intervention for improving symptoms of depression and anxiety following a major cardiac event
• Discuss the cost implications and feasibility of implementing a similar intervention

Keywords: Cardiorespiratory, Depression

Presenting author's disclosure statement:

Not Answered