Characteristics of included CC studies in the treatment of comorbid depression and CHD
| Study, country | Design and intervention length | CHD population (% CHD in total sample) | Sample size of CC vs UC (% females in total sample) | Depression assessment | CC intervention | Control group |
|---|---|---|---|---|---|---|
| Bypassing the Blues, Rollman et al, USA24 35 40 | Single-blind effectiveness RCT, 8 months | CABG (100%) | 150 CC vs 152 UC (41.4) | PHQ-2 positive screen as an inpatient and PHQ-9 score ≥10 2 weeks post-CABG, PRIME-MD for mood disorders | Structured telephone follow-up, patient preferences for depression care, psychoeducation, bibliotherapy, promoting adherence and initiation or adjustment of antidepressant pharmacotherapy provided by PCP (citalopram, SNRI or bupropion); referral to a community MHS; a combination of the above; ‘watchful-waiting’ | Usual care, given brochure on depression and heart disease; PCP informed of depression status |
| CODIACS, Davidson et al, USA18 34 | Single-blind effectiveness RCT, 6 months | UA, MI (100%) | 73 CC vs 77 UC (42.0) | BDI-I score ≥10 on 2 screening occasions or ≥15 on 1 occasion 2–6 months after hospitalisation | Initial patient preference for problem-solving therapy and/or pharmacotherapy (sertraline, citalopram, bupropion), or neither; then a stepped-care approach every 6–8 weeks, structured follow-up initially every week with PST or 1–2 and 3–5 weeks to titrate doses with pharmacotherapy; study team included a site physician and fed back information to PCP | Usual care, locally administered, ad libitum depression care; PCP informed of depression status |
| COPES, Davidson et al, USA11 22 38 39 49 | Single-blind effectiveness RCT, 6 months | UA, MI (100%) | 80 CC vs 77 UC (53.5) | BDI-I score ≥10 on 2 screening occasions 1 week and 3 months after hospitalisation | Initial patient preference for problem-solving therapy and/or pharmacotherapy (sertraline, escitalopram, venlafaxine, bupropion, mirtazapine), then a stepped-care approach, repeated assessments and augmentation if required at 8 week intervals, structured follow-up initially every week with PST or 1–2 and 3–5 weeks to titrate doses with pharmacotherapy, study team included a site physician and fed back information to PCP | Usual care, locally administered, ad libitum depression care; PCP informed of depression status |
| MOSAIC, Huffman et al, USA23 37 | Single-blind effectiveness RCT, 6 months | UA, MI, HF, arrhythmia (51%) | 92 CC vs 91 EUC (53.0) | Two-step screening process; PHQ-2, GAD-2 and item about panic attacks as an inpatient and PRIME-MD for depression, GAD and PD | Social worker and psychiatrist developed individualised treatment recommendations; patient preference for pharmacotherapy (SSRI most commonly citalopram, SNRI, bupropion, mirtazapine and anxiety treatment with SSRI or benzodiazepine) or CBT (minimum 6 session CBT when allocated); stepped-care; PCP informed of patient preference; structured telephone call and follow-up to monitor symptoms, promote adherence and engagement | Enhanced usual care; PCP informed of psychiatric status at baseline and subsequent screening |
| SUCCEED, Huffman et al, USA17 50 | Single-blind effectiveness RCT, 3 months | UA, MI, HF, arrhythmia (52.6%) | 90 CC vs 85 UC (48.6) | Two-step screening process; PHQ-2 positive screen and PHQ-9 score ≥10 as an inpatient | Social worker and psychiatrist individualised depression treatment recommendations based on history and patient preference (SSRI or psychotherapy); study team provided the PCP or cardiologist with treatment recommendations; verbal and written recommendations to the inpatient treatment team; depression education for pleasant activities scheduling; monitored for adequate depression response | Usual care; PCP informed of depression status |
| TrueBlue, Morgan et al, Australia19 36 | Cluster randomised RCT, 12 months | CHD and diabetes (57.8) | 170 CC vs 147 WLC (46.7) | PHQ-9 score ≥5 as a primary care patient | Scheduled visits to PN and PCP every 3 months over 12-months; referrals to MHS; development and recording of patient goals | Usual care; PN monitor depression by screening at scheduled intervals |
BDI-I, Beck Depression Inventory-I; CABG, coronary artery bypass graft; CBT; cognitive–behavioural therapy; CC, collaborative care; CHD, coronary heart disease; CODIACS, Comparison of Depression Interventions after Acute Coronary Syndrome (Centralized, Stepped, Patient Preference-Based Treatment for Patients With Post-Acute Coronary Syndrome Depression); COPES, Coronary Psychosocial Evaluation Studies; GAD, generalised anxiety disorder; HF, heart failure; MHS, mental health services; MI, myocardial infarction; MOSAIC, Management of Sadness and Anxiety in Cardiology; PCP, primary care physician; PD, panic disorder; PHQ, Patient Health Questionnaire; PN, practice nurse; PRIME-MD, Primary Care Evaluation of Mental Disorders; PST, problem-solving therapy; RCT, randomised controlled trial; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitors; SUCCEED, Screening Utilization and CC for More Effective and Efficient Treatment of Depression; UA, unstable angina; UC, usual care; WLC, wait-list control.