Browsing by Subject "internet interventions"

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    Effect of Depression Treatment on Health Behaviors and Cardiovascular Risk Factors Among Primary Care Patients with Depression: Data from the eIMPACT Trial
    (2023-12) Schuiling, Matthew D.; Stewart, Jesse; Hirsh, Adam; Wu, Wei
    Background. Although depression is a risk factor for cardiovascular disease (CVD), few clinical trials in people without CVD have examined the effect of depression treatment on CVD-related outcomes. It’s unknown if successful depression treatment improves indicators of CVD risk, such as CVD-relevant health behaviors, traditional CVD risk factors, and CVD events. Methods. We examined data from eIMPACT trial, a phase II randomized controlled trial conducted from 2015-2020. Depressive symptoms, CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed. Incident CVD events over four years were identified using a statewide health information exchange. Results. The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). CVD-relevant health behaviors did not mediate any intervention effects on traditional CVD risk factors. Twenty-two participants (10%) experienced an incident CVD event. The likelihood of an CVD event did not differ between the intervention group (12.1%) and the usual care group (8.3%; HR = 1.45, 95% CI: 0.62-3.40, p = 0.39). Conclusions. Successful depression treatment alone improves self-reported sleep quality but is not sufficient to lower CVD risk of people with depression. Alternative approaches may be needed reduce CVD risk in depression. Trial Registration: ClinicalTrials.gov Identifier: NCT02458690
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    Modernized Collaborative Care for Depression: Impact on Psychological Risk and Protective Factors for Diabetes and Intervention Outcomes Among Diverse Sociodemographic Groups
    (2024-08) Williams, Michelle; Stewart, Jesse; Hirsh, Adam; Johnson, India; Gupta, Samir
    Objective: We examined the effect of a modernized collaborative care intervention for depression on multiple psychological risk and protective factors for diabetes and characterized intervention process outcomes using data from the eIMPACT-DM trial. Methods: Forty-six primary care patients with depression and elevated diabetes risk from a safety net healthcare system (Mage = 50 years, 78% women, 72% Black, Meducation = 13 years, 33% with income <$10,000/year) were randomized to 6 months of the eIMPACT-DM intervention (our modernized collaborative care intervention for depression involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants; n=24) or active control (depression education, depressive symptom monitoring, and usual primary care for depression; n=22). Depressive symptoms (Patient Health Questionnaire-9 [PHQ-9], anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]), trait positive affect (Positive and Negative Affect Schedule- Positive Affect Subscale [PANAS-PA]), life satisfaction (Satisfaction With Life Scale [SWLS]), and intervention process outcomes were measured across the treatment period. Results: Effect size metrics (standardized regression coefficients; bY) indicated that, compared to active control, the intervention group demonstrated clinically meaningful medium-to-large improvements in depressive symptoms (PHQ-9 bY = -0.69), anxiety symptoms (GAD-7 bY = - 0.76), and trait positive affect (PANAS-PA bY = 0.61) as well as small-to-medium improvements in life satisfaction (bY = 0.43). Although only 27% of participants assigned to iCBT had good engagement and 60% had good iCBT comprehension, the intervention group reported high skills implementation and treatment satisfaction. Conclusion: These findings demonstrate the potential of a modernized collaborative care intervention to improve multiple psychological risk and protective factors for diabetes in a diverse primary care population. Such an intervention could ultimately serve to bolster future diabetes prevention in diverse groups, helping to reduce diabetes-related health disparities.