Year of Publication

2010

Degree Name

Doctor of Philosophy (PhD)

Document Type

Dissertation

College

Nursing

Department

Nursing

First Advisor

Dr. Terry A. Lennie

Abstract

Depressive symptoms are common in patients with heart failure (HF) and adversely affect mortality, morbidity, and health-related quality of life. Cognitive therapy (CT) has been proposed as a non-pharmacological treatment for depressive symptoms in patients with HF. However, there is currently little evidence to support use of CT in patients with HF.

The purpose of this dissertation was to develop and test a brief, nurse-delivered CT intervention for the treatment of depressive symptoms in patients with HF. Prior to testing the intervention, preliminary work was conducted resulting in four manuscripts: 1) a review of the evidence for CT in treating depressive symptoms in patients with cardiovascular conditions, 2) a description of living with depressive symptoms in patients with HF and strategies that could be used to manage these symptoms, 3) a review of measures of negative thinking and the identification of a measure of negative thinking that can be used in patients with HF, and 4) an evaluation of the psychometric properties of this measure. Based on information from these manuscripts, a randomized, controlled pilot study was conducted to test the effects of a brief CT intervention on outcomes of hospitalized patients with HF who report depressive symptoms.

Forty-two hospitalized patients with HF with mild-moderate depressive symptoms were randomized to a brief CT intervention focused on reducing negative thoughts with thought-stopping and affirmations, or to usual care control. Both groups experienced improvements in depressive symptoms, health-related quality of life, and negative thinking at one week and three months. However, the intervention group experienced longer cardiac event-free survival and fewer cardiovascular hospitalizations and emergency department visits at three months when compared to the control group.

This dissertation has fulfilled an important gap in the evidence base for depression treatment in patients with HF by demonstrating that a nurse-delivered, brief CT intervention may improve cardiac event-free survival in patients with HF. This brief CT intervention is replicable, practical, can be delivered by acute care nurses, and may improve clinical outcomes in patients with HF. Additional research is needed to determine the effects of the intervention on long-term outcomes in patients with HF.

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