A Collaborative Care Program to Improve Treatment of Depression and Anxiety Disorders in Cardiac Patients
Condition: Depression; Generalized Anxiety Disorder; Panic Disorder
MeSH terms: Depression; Depressive Disorder; Anxiety Disorders; Panic Disorder
Intervention: Collaborative care; Usual care
Intervention description: Study care manager provides psychoeducation, therapy, and care coordination between patient, psychiatrist, and primary medical physicians.; Patient's primary medical physician informed of mental health symptoms/diagnosis
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 183.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Collaborative care; Cardiovascular disease; Depression; Anxiety

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.
    

Eligibility criteria:

        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