Abstract Body (Do not enter title and authors here): Background: Depressive symptoms are prevalent in patients with coronary heart disease (CHD) and heart failure (HF) living in rural areas and are associated with worse health outcomes. Cognitive behavioral therapy (CBT) has been shown to be effective at improving depressive symptoms in patients with CHD and HF. Traditional CBT is not accessible to many rural individuals, thus alternative virtual modalities are being tested to ascertain their effectiveness. Cognitive impairment is a core feature of depressive disorders and is prevalent in up to 95% of all clinical depression diagnoses. It is unknown how cognition impacts the reduction of depressive symptoms in patients utilizing virtual CBT interventions.
Aim: To determine if cognition moderates the impact of two different modalities of virtual CBT on depressive symptoms over a 12-month period.
Methods: This is an on-going 12-month randomized comparative effectiveness trial. Participants with at least mild depressive symptoms were randomly assigned to CBT with either a video-conference with a therapist or a self-directed internet-based application. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ9) and were measured at baseline, 3-, 6-, and 12-months. Cognition was measured at baseline using two instruments, the MOCA and the Mini-Cog. Those with significant cognitive dysfunction were excluded from the study. Scores were standardized from both instruments using Z-scores and separated by the median into lower cognitive function and higher cognitive function. Repeated measures ANOVA was performed to determine whether cognitive function interacted with either intervention to produce an effect on depressive symptoms over time.
Results: Participants (n=305) were 58±12 years old, 49% female, and had 13±3 years of education. Baseline PHQ-9 scores showed no significant difference between lower and higher cognition groups. (12±6 vs 11±5, respectively, p=.17). There was no interaction of cognition by intervention group on depressive symptoms (p=0.217). Both intervention groups had significant decreases in depressive symptoms over time (p<0.001 for time effect). There was no between-group difference in improvement of depressive symptoms (p=0.059).
Conclusion: Both cognitive groups experience significant symptom reduction with virtual CBT, suggesting effectiveness regardless of cognitive function in rural CHD and HF patients, provided significant cognitive dysfunction is absent.