This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Patient-Physician Relationship/ Care  • Psychosocial Issues  • Psychiatry  • Depression  • Cardiovascular System  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial

Writing Committee for the ENRICHD Investigators

JAMA. 2003;289:3106-3116.

Context  Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment.

Objective  To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI.

Design, Setting, and Patients  Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention.

Intervention  Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks.

Main Outcome Measures  Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months.

Results  Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients).

Conclusions  The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.

Authors/Writing Committee for the ENRICHD Investigators: Lisa F. Berkman, PhD (study chair and coprincipal investigator), Harvard University, Boston, Mass; James Blumenthal, PhD (principal investigator), Duke University, Durham, NC; Matthew Burg, PhD (principal investigator), Yale University, New Haven, Conn; Robert M. Carney, PhD (principal investigator), Washington University, St Louis, Mo; Diane Catellier, DrPH (principal investigator), University of North Carolina at Chapel Hill; Marie J. Cowan, PhD, RN, University of California, Los Angeles; Susan M. Czajkowski, PhD (project officer and writing committee chair), National Heart, Lung, and Blood Institute, Bethesda, Md; Robert DeBusk, MD (principal investigator), Stanford University, Palo Alto, Calif; James Hosking, PhD (principal investigator, 1995-2001), University of North Carolina at Chapel Hill; Allan Jaffe, MD (study cochair), Mayo Clinic, Rochester, Minn; Peter G. Kaufmann, PhD, National Heart, Lung, and Blood Institute, Bethesda, Md; Pamela Mitchell, PhD (principal investigator), University of Washington, Seattle; James Norman, PhD, National Heart, Lung, and Blood Institute, Bethesda, Md; Lynda H. Powell, PhD (principal investigator), Rush Presbyterian-St Luke's Medical Center, Chicago, Ill; James M. Raczynski, PhD (principal investigator), University of Alabama at Birmingham; Neil Schneiderman, PhD (principal investigator), University of Miami, Coral Gables, Fla. Dr Raczynski is now with the University of Arkansas for Medical Sciences, Little Rock.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Depression--A Cardiac Risk Factor in Search of a Treatment
and
JAMA. ;289():3171-3173.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevention of Major Depression in Complex Medically Ill Patients: Preliminary Results From a Randomized, Controlled Trial
de Jonge et al.
Psychosomatics 2009;50:227-233.
ABSTRACT | FULL TEXT  

Depressive Symptom Dimensions and Cardiovascular Prognosis Among Women With Suspected Myocardial Ischemia: A Report From the National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation
Linke et al.
Arch Gen Psychiatry 2009;66:499-507.
ABSTRACT | FULL TEXT  

Caregiver-assisted coping skills training for patients with COPD: background, design, and methodological issues for the INSPIRE-II study
Blumenthal et al.
Clin Trials 2009;6:172-184.
ABSTRACT  

Treatment-Resistant Depression and Mortality After Acute Coronary Syndrome
Carney and Freedland
Am. J. Psychiatry 2009;166:410-417.
ABSTRACT | FULL TEXT  

Treatment of Depression After Coronary Artery Bypass Surgery: A Randomized Controlled Trial
Freedland et al.
Arch Gen Psychiatry 2009;66:387-396.
ABSTRACT | FULL TEXT  

Depression and heart rate variability in patients with coronary heart disease
CARNEY and FREEDLAND
Cleveland Clinic Journal of Medicine 2009;76:S13-S17.
ABSTRACT | FULL TEXT  

History of Depression and Survival After Acute Myocardial Infarction
Carney et al.
Psychosom. Med. 2009;71:253-259.
ABSTRACT | FULL TEXT  

Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience
Bang et al.
Nephrol Dial Transplant 2009;0:gfp124v1-gfp124.
ABSTRACT | FULL TEXT  

Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study.
Whang et al.
J Am Coll Cardiol 2009;53:950-958.
ABSTRACT | FULL TEXT  

Depression, cardiac mortality and all-cause mortality
Seymour and Benning
Adv. Psychiatr. Treat. 2009;15:107-113.
ABSTRACT | FULL TEXT  

Status of Women in Cardiovascular Clinical Trials
Kim and Menon
Arterioscler. Thromb. Vasc. Bio. 2009;29:279-283.
FULL TEXT  

Health care use in depressed, elderly, cardiac patients and the effect of antidepressant use
Blanchette et al.
Am J Health Syst Pharm 2009;66:366-372.
ABSTRACT | FULL TEXT  

Social networks and health: A life course perspective integrating observational and experimental evidence
Ertel et al.
Journal of Social and Personal Relationships 2009;26:73-92.
 

The Bypassing the Blues Treatment Protocol: Stepped Collaborative Care for Treating Post-CABG Depression
Rollman et al.
Psychosom. Med. 2009;71:217-230.
ABSTRACT | FULL TEXT  

Depression and heart disease: What do we know, and where are we headed?
POZUELO et al.
Cleveland Clinic Journal of Medicine 2009;76:59-70.
ABSTRACT | FULL TEXT  

AAFP Guideline for the Detection and Management of Post-Myocardial Infarction Depression
Post-Myocardial Infarction Depression Clinical Pra
Ann Fam Med 2009;7:71-79.
FULL TEXT  

Stress Reduction Prolongs Life in Women With Coronary Disease: The Stockholm Women's Intervention Trial for Coronary Heart Disease (SWITCHD)
Orth-Gomer et al.
Circ Cardiovasc Qual Outcomes 2009;2:25-32.
ABSTRACT | FULL TEXT  

Impact of Depression on Sex Differences in Outcome After Myocardial Infarction
Parashar et al.
Circ Cardiovasc Qual Outcomes 2009;2:33-40.
ABSTRACT | FULL TEXT  

Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms.
Hamer et al.
J Am Coll Cardiol 2008;52:2156-2162.
ABSTRACT | FULL TEXT  

Psychological distress and cardiovascular risk: what are the links?
von Kanel
J Am Coll Cardiol 2008;52:2163-2165.
FULL TEXT  

Psychiatric Hospital Admissions, Behavioral Risk Factors, and All-Cause Mortality: The Scottish Health Survey
Hamer et al.
Arch Intern Med 2008;168:2474-2479.
ABSTRACT | FULL TEXT  

Depressive Symptoms, Health Behaviors, and Risk of Cardiovascular Events in Patients With Coronary Heart Disease
Whooley et al.
JAMA 2008;300:2379-2388.
ABSTRACT | FULL TEXT  

Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
Thombs et al.
JAMA 2008;300:2161-2171.
ABSTRACT | FULL TEXT  

Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Lichtman et al.
Circulation 2008;118:1768-1775.
ABSTRACT | FULL TEXT  

Smoking Behavior Postmyocardial Infarction Among ENRICHD Trial Participants: Cognitive Behavior Therapy Intervention for Depression and Low Perceived Social Support Compared With Care as Usual
Trockel et al.
Psychosom. Med. 2008;70:875-882.
ABSTRACT | FULL TEXT  

Invited Commentary: Stress and Mortality
Hotopf et al.
Am J Epidemiol 2008;168:492-495.
ABSTRACT | FULL TEXT  

Nighttime Heart Rate and Survival in Depressed Patients Post Acute Myocardial Infarction
Carney et al.
Psychosom. Med. 2008;70:757-763.
ABSTRACT | FULL TEXT  

Heterogeneity of Patients With Coronary Artery Disease and Distress and the Need to Identify Relevant Subtypes
de Jonge and Ormel
Arch Gen Psychiatry 2008;65:851-852.
FULL TEXT  

Angina at 1 Year After Myocardial Infarction: Prevalence and Associated Findings
Maddox et al.
Arch Intern Med 2008;168:1310-1316.
ABSTRACT | FULL TEXT  

Take a walk on the wild side of social epidemiology
Cwikel
Int J Epidemiol 2008;37:683-684.
FULL TEXT  

Case 14-2008 -- A 78-Year-Old Man with Anergia and Anhedonia Associated with Cardiovascular Surgery
Huffman et al.
NEJM 2008;358:2051-2059.
FULL TEXT  

Depressive Symptoms and the Risk of Atherosclerotic Progression Among Patients With Coronary Artery Bypass Grafts
Wellenius et al.
Circulation 2008;117:2313-2319.
ABSTRACT | FULL TEXT  

Remission From Depression Comorbid With Chronic Illness and Physical Impairment
Turvey and Klein
Am. J. Psychiatry 2008;165:569-574.
FULL TEXT  

Cardiac Disease, Depressive Symptoms, and Incident Stroke in an Elderly Population
Wouts et al.
Arch Gen Psychiatry 2008;65:596-602.
ABSTRACT | FULL TEXT  

New Onset Depression Following Myocardial Infarction Predicts Cardiac Mortality
Dickens et al.
Psychosom. Med. 2008;70:450-455.
ABSTRACT | FULL TEXT  

Depressive Symptoms Predict Heart Rate Recovery After Exercise Treadmill Testing in Patients With Coronary Artery Disease: Results From the Psychophysiological Investigations of Myocardial Ischemia Study
Hughes et al.
Psychosom. Med. 2008;70:456-460.
ABSTRACT | FULL TEXT  

Depression, antidepressants and heart disease
DTB 2008;46:29-32.
ABSTRACT | FULL TEXT  

Elevated Inflammation Levels in Depressed Adults With a History of Childhood Maltreatment
Danese et al.
Arch Gen Psychiatry 2008;65:409-415.
ABSTRACT | FULL TEXT  

Effect of Selective Serotonin Reuptake Inhibitors on Cardiovascular Morbidity and Mortality
Von Ruden et al.
J CARDIOVASC PHARMACOL THER 2008;13:32-40.
ABSTRACT  

Social Support and Stroke and Coronary Heart Disease: The JPHC Study Cohorts II
Ikeda et al.
Stroke 2008;39:768-775.
ABSTRACT | FULL TEXT  

Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack
Wong et al.
QJM 2008;101:137-144.
ABSTRACT | FULL TEXT  

Psychological treatment of cardiac patients: a meta-analysis
Linden et al.
Eur Heart J 2007;28:2972-2984.
ABSTRACT | FULL TEXT  

Rationale and design of a randomised, controlled, multicenter trial investigating the effects of selective serotonin re-uptake inhibition on morbidity, mortality and mood in depressed heart failure patients (MOOD-HF)
Angermann et al.
Eur J Heart Fail 2007;9:1212-1222.
ABSTRACT | FULL TEXT  

Sex, Depression, and Risk of Hospitalization and Mortality in Chronic Obstructive Pulmonary Disease
Fan et al.
Arch Intern Med 2007;167:2345-2353.
ABSTRACT | FULL TEXT  

Understanding prognostic benefits of exercise and antidepressant therapy for persons with depression and heart disease: the UPBEAT study rationale, design, and methodological issues
Blumenthal et al.
Clin Trials 2007;4:548-559.
ABSTRACT  

Depression and Coronary Heart Disease: More Pieces of the Puzzle
Carney and Freedland
Am. J. Psychiatry 2007;164:1307-1309.
FULL TEXT  

Nonresponse to Treatment for Depression Following Myocardial Infarction: Association With Subsequent Cardiac Events
de Jonge et al.
Am. J. Psychiatry 2007;164:1371-1378.
ABSTRACT | FULL TEXT  

Heart Rate Variability in Acute Coronary Syndrome Patients With Major Depression: Influence of Sertraline and Mood Improvement
Glassman et al.
Arch Gen Psychiatry 2007;64:1025-1031.
ABSTRACT | FULL TEXT  

Treatment of Post-Myocardial Infarction Depressive Disorder: A Randomized, Placebo-Controlled Trial With Mirtazapine
Honig et al.
Psychosom. Med. 2007;69:606-613.
ABSTRACT | FULL TEXT  

The Association Between Depression, Lung Function, and Health-Related Quality of Life Among Adults With Cystic Fibrosis
Riekert et al.
Chest 2007;132:231-237.
ABSTRACT | FULL TEXT  

Spirituality, Religion, and Clinical Outcomes in Patients Recovering From an Acute Myocardial Infarction
Blumenthal et al.
Psychosom. Med. 2007;69:501-508.
ABSTRACT | FULL TEXT  

Performance Characteristics of Depression Screening Instruments in Survivors of Acute Myocardial Infarction: Review of the Evidence
Thombs et al.
Psychosomatics 2007;48:185-194.
ABSTRACT | FULL TEXT  

Effects of antidepressant treatment following myocardial infarction
van MELLE et al.
Br. J. Psychiatry 2007;190:460-466.
ABSTRACT | FULL TEXT  

Does treating depression improve survival after acute coronary syndrome?: Invited commentary on... Effects of antidepressant treatment following myocardial infarction
CARNEY and FREEDLAND
Br. J. Psychiatry 2007;190:467-468.
ABSTRACT | FULL TEXT  

The Effect of a Primary Care Practice-Based Depression Intervention on Mortality in Older Adults: A Randomized Trial
Gallo et al.
ANN INTERN MED 2007;146:689-698.
ABSTRACT | FULL TEXT  

Depression Is a Risk Factor for Mortality After Myocardial Infarction: Fact or Artifact?
Dickens et al.
J Am Coll Cardiol 2007;49:1834-1840.
ABSTRACT | FULL TEXT  

Et al
Evid. Based Ment. Health 2007;10:39-40.
FULL TEXT  

Depression and Heart Failure: Why the Link Continues to Elude Us
Persaud
J Am Coll Cardiol 2007;49:1503-1504.
FULL TEXT  

Care Management of Poststroke Depression: A Randomized, Controlled Trial
Williams et al.
Stroke 2007;38:998-1003.
ABSTRACT | FULL TEXT  

Depression and anxiety after myocardial infarction
de Jonge and Ormel
Br. J. Psychiatry 2007;190:272-273.
FULL TEXT  

Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) Trial
Lesperance et al.
JAMA 2007;297:367-379.
ABSTRACT | FULL TEXT  

Antidepressants in Coronary Heart Disease: SSRIs Reduce Depression, But Do They Save Lives?
Glassman and Bigger
JAMA 2007;297:411-412.
FULL TEXT  

Heart Rate Turbulence, Depression, and Survival After Acute Myocardial Infarction
Carney et al.
Psychosom. Med. 2007;69:4-9.
ABSTRACT | FULL TEXT  

Depression After Myocardial Infarction: Unraveling the Mystery of Poor Cardiovascular Prognosis and Role of Beta-Blocker Therapy
von Kanel and Begre
J Am Coll Cardiol 2006;48:2215-2217.
FULL TEXT  

Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events
de Jonge et al.
J Am Coll Cardiol 2006;48:2204-2208.
ABSTRACT | FULL TEXT  

Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies
Nicholson et al.
Eur Heart J 2006;27:2763-2774.
ABSTRACT | FULL TEXT  

Case 34-2006 -- A 72-Year-Old Woman with Nausea Followed by Hypotension and Respiratory Failure
Johnson et al.
NEJM 2006;355:2022-2031.
FULL TEXT  

Psychosocial Benefits of Three Formats of a Standardized Behavioral Stress Management Program
Kirby et al.
Psychosom. Med. 2006;68:816-823.
ABSTRACT | FULL TEXT  

Rapid screening for major depression in post-myocardial infarction patients: an investigation using Beck Depression Inventory II items
Huffman et al.
Heart 2006;92:1656-1660.
ABSTRACT | FULL TEXT  

Depression in Heart Failure: A Meta-Analytic Review of Prevalence, Intervention Effects, and Associations With Clinical Outcomes
Rutledge et al.
J Am Coll Cardiol 2006;48:1527-1537.
ABSTRACT | FULL TEXT  

Time course of depression and outcome of myocardial infarction.
Parashar et al.
Arch Intern Med 2006;166:2035-2043.
ABSTRACT | FULL TEXT  

Assessment and treatment of depression in patients with cardiovascular disease: national heart, lung, and blood institute working group report.
Davidson et al.
Psychosom. Med. 2006;68:645-650.
ABSTRACT | FULL TEXT  

Course of Depressive Symptoms After Myocardial Infarction and Cardiac Prognosis: A Latent Class Analysis
Kaptein et al.
Psychosom. Med. 2006;68:662-668.
ABSTRACT | FULL TEXT  

Minor Depression as a Cardiac Risk Factor After Coronary Artery Bypass Surgery
Rafanelli et al.
Psychosomatics 2006;47:289-295.
ABSTRACT | FULL TEXT  

Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons.
Nielsen et al.
J. Epidemiol. Community Health 2006;60:721-728.
ABSTRACT | FULL TEXT  

Depression Symptom Severity and Reported Treatment History in the Prediction of Cardiac Risk in Women With Suspected Myocardial Ischemia: The NHLBI-Sponsored WISE Study.
Rutledge et al.
Arch Gen Psychiatry 2006;63:874-880.
ABSTRACT | FULL TEXT  

THE GREAT DEBATE EDITORIAL, REVISITED
Schneiderman and Williams
Psychosom. Med. 2006;68:636-638.
FULL TEXT  

Depression and cardiovascular disease: healing the broken-hearted.
Whooley
JAMA 2006;295:2874-2881.
ABSTRACT | FULL TEXT  

Mind your heart.
Whooley
ANN INTERN MED 2006;144:858-860.
FULL TEXT  

Symptoms of Posttraumatic Stress Disorder in Patients Who Have Had a Myocardial Infarction
Shemesh et al.
Psychosomatics 2006;47:231-239.
ABSTRACT | FULL TEXT  

Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women.
Mallik et al.
Arch Intern Med 2006;166:876-883.
ABSTRACT | FULL TEXT  

Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit.
Glassman et al.
Arch Gen Psychiatry 2006;63:283-288.
ABSTRACT | FULL TEXT  

The Great Debate, revisited.
Freedland et al.
Psychosom. Med. 2006;68:179-184.
FULL TEXT  

Genetic pleiotropy in depression and coronary artery disease.
de Geus
Psychosom. Med. 2006;68:185-186.
FULL TEXT  

Depression is associated with cardiac symptoms, mortality risk, and hospitalization among women with suspected coronary disease: the NHLBI-sponsored WISE study.
Rutledge et al.
Psychosom. Med. 2006;68:217-223.
ABSTRACT | FULL TEXT  

Symptom Dimensions of Depression Following Myocardial Infarction and Their Relationship With Somatic Health Status and Cardiovascular Prognosis
de Jonge et al.
Am. J. Psychiatry 2006;163:138-144.
ABSTRACT | FULL TEXT  

Design and Rationale for a Randomized, Controlled Trial of Interpersonal Psychotherapy and Citalopram for Depression in Coronary Artery Disease (CREATE)
Frasure-Smith et al.
Psychosom. Med. 2006;68:87-93.
ABSTRACT | FULL TEXT  

Depression and disability in coronary patients: time to focus on quality of life as an end point
Haas
Heart 2006;92:8-10.
FULL TEXT  

Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months
de Jonge et al.
Heart 2006;92:32-39.
ABSTRACT | FULL TEXT