Willingness to Engage in Traditional and Novel Depression Treatment Modalities Among Myocardial Infarction Survivors
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Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA; 2Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA; 3Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; 4Case Western Reserve University, Cleveland, OH, USA; 5The Columbia School of Social Work, Columbia University, New York, NY, USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05406-8 © Society of General Internal Medicine 2019
INTRODUCTION
Depression is a known risk factor for morbidity and mortality following myocardial infarction (MI).1 Several groups, including the American Heart Association, recommend depression screening and treatment post-MI.2 Yet, fewer post-MI survivors receive depression treatment than general depressed populations.3 To inform implementation efforts, we assessed depression treatment attitudes, acceptability, and willingness (by modality) among MI survivors with elevated depressive symptoms.
METHODS
From May 2013 to July 2013, YouGov, a non-partisan online polling firm, administered English and Spanish surveys to 1500 US opt-in survey panel participants reporting MI diagnosis by a healthcare professional. Sampling targets were based on age, sex, and race distribution of MI in the 2010 National Health Interview Survey (NHIS) using a two-step sample matching method that drew a random sample from the target population and then created a matched set of survey respondents to these marginals (response rates 45.8% English; 16.2% Spanish).3 We restricted analyses to participants with elevated depressive symptoms (Patient Health Questionnaire8 ≥ 10). We elicited medical history and current/past depression treatment use, attitudes (i.e., importance of dealing with MI-related stress, interest in talking about one’s feelings (including if offered at no cost), and willingness by modality (defined as ≥ 3 [very/somewhat interested] on a 4-point Likert scale): face-to-face counseling, antidepressants, group therapy Received August 1, 2019 Accepted September 20, 2019
(including social groups, e.g., exercise), remote therapy (telephone or video counseling), and self-help (here online or smartphone application-delivered). We used sampling weights based on 2010 NHIS age, gender, and race distributions of MI to calculate weighted percentages. Weighted multivariable logistic regression determined the association between key demographic characteristics (age, gender, race/ethnicity) and treatment willingness adjusting for income, education, and history of depression based on a priori hypotheses.
RESULTS
Overall, 352 (weighted percentage 23.7%) of 1500 MI participants had elevated depressive symptoms: average age (standard error) 59.6 (0.69) years; 50.4% were female, and 23.9% non-white; 79.6% reported a history of hypertension, 78.7% high cholesterol, 47.3% heart failure, and 44.3% diabetes; 69.5% had prior depression (Table 1). Overall, 20.0% were currently receiving therapy, but 7
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