Clinical predictors of depression treatment outcomes in patients with coronary heart disease

• Cardiac patients who do not respond to depression treatment are at risk for mortality.
• Patients with major depression and heart disease were treated for depression.
• Financial and interpersonal stressors during treatment predicted depression outcomes.
• Medical hospitalizations and medical emergencies did not.
• Financial and interpersonal stressors should be addressed in depressed cardiac patients.

ObjectivesPatients with coronary heart disease (CHD) who respond to treatment for depression are at lower risk of mortality than are nonresponders. This study sought to determine whether variables that have been shown to predict both depression treatment outcomes in psychiatric patients and cardiac events in patients with CHD, also predict poor response to depression treatment in patients with CHD.MethodsOne hundred fifty-seven patients with stable CHD who met the DSM-IV criteria for a major depressive episode were treated with cognitive behavior therapy (CBT) for 16 weeks, either alone or in combination with an antidepressant.ResultsThe mean Beck Depression Inventory (BDI-II) score was 30.2 ± 8.5 at baseline and 8.5 ± 7.8 at 16 weeks. Over 50% of the participants were in remission (HAM-D-17 score ≤ 7) at the end of treatment. Of the hypothesized predictors, severe depression at baseline (p = 0.02), stressful life events during the first (p = 0.03) and last (p < 0.0001) 8 weeks of treatment, and the completion of CBT homework assignments (p = 0.001) predicted