Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Collaborative Care Program to Improve Treatment of Depression and Anxiety Disorders in Cardiac Patients (MOSAIC)
Brief Summary: For this trial, the investigators propose a prospective trial of a collaborative care program to identify and treat depression, generalized anxiety disorder, and panic disorder among patients admitted to the hospital for an acute cardiac illness (acute coronary syndrome, congestive heart failure, or arrhythmia). Such assessment and treatment for depression/generalized anxiety disorder/panic disorder will begin in the hospital, and ongoing management will continue for six months following discharge.

The investigators hypothesize that this model will lead to increased treatment rates, improved mood, reduced anxiety, and improved medical outcomes in this vulnerable population. If this model is effective, it could be implemented clinically to provide better and more complete care to patients hospitalized with acute cardiac illness, for whom depression and anxiety may be a risk factor for complications and death.

This will be a two-arm, single-blind randomized controlled trial, with one-half of patients randomized to collaborative care and one-half randomized to the control condition (usual care). Psychiatric treatment in the intervention arm will be provided in concert with patients' primary care physicians-with primary care physicians prescribing all medications-within a framework supervised by a psychiatrist.

The investigators will enroll patients who have any (or all) of the three included psychiatric diagnoses to improve the utility of the intervention. The investigators have chosen to enroll patients with several different cardiac diagnoses. This will allow the researchers to include patients with heterogeneous diagnoses and illness severity to determine if our intervention is effective in a broad population of patients with heart disease. The investigators will study an intervention targeting depression, generalized anxiety disorder, and panic disorder: all three disorders are disabling and associated with adverse cardiovascular outcomes, treatments for the conditions are highly similar, the investigators can treat patients who have more than one disorder, and a prior outpatient program successfully simultaneously addressed more than one mental health condition.

The project will involve: (1) screening patients for depression, generalized anxiety disorder, and panic disorder as part of usual clinical care, (2) evaluation of positive-screen patients by a study social work care manager, (3) a multicomponent in-hospital intervention (for collaborative care patients) that involves patient education, specialist-provided treatment recommendations, and a goal of in-hospital treatment initiation, and (4), after discharge, continued phone-based evaluation and care coordination with primary care physicians to provide stepwise treatment in the collaborative care arm. The intervention has been designed to be low-cost, low-burden, and easily generalizable to other settings.


Options:
A: Inclusion Criteria:

* Patients with coronary artery disease
* German speaking men and women
* Recent coronary angiogram (\<= 3 months old)
* Depression score (HADS-D) \>= 8
* Written informed consent

Exclusion Criteria:

* Severe heart failure
* Other acutely life- threatening conditions
* Severe chronic inflammatory disease
* Current suicidal tendency
* Severe depressive episode
* Other severe mental illness.
B: Inclusion Criteria:

* Currently receiving medical care at Johns Hopkins University
* African American or Caucasian and have diagnosed CVD, defined as a prior myocardial infarction, revascularization procedure for coronary disease, ischemic heart disease, stroke, or have diagnosed type 2 diabetes and not receiving any therapy
* Have either no LDL-C in their medical record during the 12 months prior to study entry or have an LDL greater than or equal to 100 mg/dl on or off lipid lowering pharmacotherapy
* Have either no blood pressure recorded in their medical record during the 12 months prior to study entry or a BP greater than 140/90 mmHg or greater than 130/80 mmHg if the participant is diabetic or has renal insufficiency
* If the participant is diabetic he or she has to either have no HbA1c recorded during the 12 months prior to study entry or HbA1c of 7 percent or greater

Exclusion criteria:

* A serious life-threatening noncardiac comorbidity with a life expectancy of less than 5 years
* A serious physician-recorded psychiatric morbidity that would interfere with the study
* Sufficient neurological impairment that would interfere with the study
C: Inclusion Criteria:

* Adult (age 18-up)admitted to inpatient cardiac unit at Massachusetts General Hospital
* Primary diagnosis of acute coronary syndrome, congestive heart failure, or arrhythmia
* Positive anxiety or depression screen during initial nursing intake interview that is performed as part of usual clinical care
* Meets criteria for clinical depression, generalized anxiety disorder, or panic disorder

Exclusion Criteria:

* Bipolar disorder
* Substance use disorder
* Psychosis
* Cognitive disorder
* Active suicidal ideation
* Medical condition with likely survival less than 6 months
* Non-English speaking
D: Inclusion Criteria:

* Recently underwent CABG (combined or redo procedure) at one of 8 Pittsburgh area study hospitals
* A PHQ score greater than 10 OR if nondepressed control, a PHQ score less than 5 at both 2 days post CABG to the date of discharge following CABG and when reassessed 2 weeks after hospital discharge
* Folstein Mini-Mental State Examination (MMSE) score greater than or equal to 24
* Able to be evaluated and treated for depression as an outpatient post CABG
* Has a household telephone

Exclusion Criteria:

* Presently in treatment with a mental health specialist
* Actively suicidal
* History of psychotic illness
* History of bipolar illness according to subject self-report and past medical history
* Current alcohol dependence or other substance abuse as evidenced by chart review and the CAGE questionnaire
* Organic mood syndromes, including those secondary to medical illness or drugs
* Presence of non-cardiovascular conditions that are likely to be fatal within 1 year
* Unstable medical condition as indicated by history, physical, and/or laboratory findings
* Previous enrollment in the study cohort
* Non-English speaking, illiterate, or possessing any other communication barrier
* If nondepressed control, current or previous diagnosis or treatment of depression

Answer: C