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From the ENRICHD Coordinating Center, Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina. ENRICHD investigators are listed in the Appendix.
Address reprints requests to: The ENRICHD Coordinating Center, University of North Carolina, Department of Biostatistics, CB#8030, Collaborative Studies Coordinating Center, 137 East Franklin Street, Suite 203, Chapel Hill, NC 27514-4145.
OBJECTIVE: Depression and low social support are risk factors for medical morbidity and mortality after acute MI. The ENRICHD study is a multicenter, randomized, controlled clinical trial of a cognitive-behavioral treatment for depression and low social support in post-MI patients. A total of 2481 patients were recruited (26% with low social support, 39% with depression, and 34% with low social support and depression). Our objective is to describe the rationale, design, and delivery of the ENRICHD intervention.
METHODS: Key features of the intervention include the integration of cognitive-behavioral and social learning approaches to the treatment of depression and a diverse set of problems that can contribute to low social support; rapid initiation of treatment after MI; a combination of individual and group modalities; adjunctive pharmacotherapy for severe or intractable depression; training, certification, and supervision of therapists; and quality assurance procedures.
RESULTS: The trial’s psychosocial and medical outcomes will be presented in future reports.
CONCLUSIONS: The ENRICHD protocol targets two complex psychosocial risk factors with a multifaceted intervention, which is delivered in an individualized manner to accommodate a demographically, medically, and psychiatrically diverse patient population. Additional research will be needed to identify optimal matches between patient characteristics and specific components of the intervention.
Key Words: myocardial infarction • coronary heart disease • depression • social support • clinical trials
Abbreviations: ENRICHD = Enhancing Recovery in Coronary Heart Disease Patients;; MI = myocardial infarction;; CHD = coronary heart disease;; CAD = coronary artery disease;; CBT = cognitive behavior therapy;; DISH = depression interview and structured Hamilton;; DIS = diagnostic interview schedule;; LPSS = low perceived social support;; BDI = Beck Depression Inventory;; SSRI = selective serotonin reuptake inhibitor;; PSSS = Perceived Social Support Scale.
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