Beating the Blues for Your Heart (BtB-Heart)

Computer-Based Depression Treatment to Reduce Coronary Artery Disease Risk

The objective of this clinical trial is to evaluate whether a computerized depression treatment, delivered before the onset of heart disease, reduces the risk of heart disease in the future. Participants in this trial will be primary care patients who are depressed but do not have a history of heart disease. Half of these patients will receive a standard treatment (usual care), and the other half will receive eight weeks of an evidence-based psychological treatment called Beating the Blues®, which is a computerized, cognitive behavioral treatment program for depression. To evaluate change in heart disease risk, the investigators will measure the functioning of the arteries using ultrasound before and after the treatment. It is hypothesized that patients who receive Beating the Blues® will show greater improvements in both depression and artery function than patients who receive standard treatment.

Study Overview

• Status: Completed
• Conditions: Depression; Depressive Symptoms; Heart Disease; Coronary Artery Disease (CAD); Cardiovascular Disease (CVD)
• Intervention / Treatment: Behavioral: Beating the Blues (BtB); Other: Usual Care

Detailed Description

Depression is an independent risk factor for coronary artery disease (CAD); unfortunately, past trials have not detected a cardiovascular benefit. A promising and unexplored explanation for these results is that the interventions were delivered too late in the natural history of CAD. Because no study has evaluated this possibility, there is a critical need to determine whether evidence-based depression treatment, delivered before the onset of clinical CAD, reduces cardiovascular risk. Accordingly, the objective of the proposed clinical and translational research is to perform a preliminary evaluation of the efficacy of a highly disseminable depression intervention in decreasing CAD risk. To achieve this goal, a clinical trial of depressed primary care patients free of cardiovascular disease is being conducted. Patients will be randomized to usual care or a computer-based, cognitive behavioral intervention called Beating the Blues®, the most widely used and empirically supported computerized treatment program for depression. The primary outcome is brachial artery flow-mediated dilation, a noninvasive measure of endothelial function. The specific aim of the proposed trial is to evaluate whether Beating the Blues®, delivered prior to the onset of clinical CAD, improves endothelial dysfunction. Demonstrating that earlier treatment of depression with Beating the Blues lowers CAD risk, the long-term expected outcome, would place computed-based depression treatment in the armamentarium of CAD prevention strategies of the primary care provider. This change to clinical practice should result in improved cardiovascular risk management, which in turn would translate into reduced CAD morbidity and mortality.

• Study Type: Interventional
• Enrollment (Actual): 29
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Indiana University-Purdue University Indianapolis (IUPUI)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Primary care patients
• Age ≥40 years
• Clinically significant depressive symptoms (Patient Health Questionnaire-9 ≥10)
• No history of cardiovascular disease

Exclusion Criteria:

• Pregnant women
• A history of chronic disorders (HIV/AIDS, chronic kidney disease, systemic inflammatory disease, or past-year cancer)
• Current use of anticoagulants or vasodilators (antihypertensive and lipid-lowering medications are allowed)
• Current drinking problem
• History of bipolar disorder or psychosis
• Ongoing treatment for depression with a psychiatrist or psychologist/ counselor (antidepressants alone are allowed)
• Severe cognitive impairment
• Acute risk of suicide
• Significant vision or hearing problems
• Individuals who do not read or speak English

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Beating the Blues (BtB); An 8-session, empirically supported, computerized, cognitive-behavioral intervention for depression (www.beatingthebluesus.com)	Behavioral: Beating the Blues (BtB); BtB is a widely used, empirically supported, computer-based, CBT program for depression designed for use in primary care clinics. BtB utilizes an interactive, multimedia format to deliver and eight 50-minute, weekly therapy sessions. General topics covered include identifying and challenging automatic thoughts, cognitive errors, core beliefs, and attributional styles; activity scheduling; problem solving; graded exposure; task breakdown; sleep management; and relapse prevention. In addition to session work, patients are assigned homeworks that are customized to their needs and reviewed at the start of each session. A progress report, including whether the patient is experiencing suicidal ideation, is generated at the end of each session.; Other Names: Computer-Based Cognitive Behavioral Therapy (CBT); Computer-Based Psychotherapy
Other: Usual Care; Patients and their primary care providers were informed of the positive depression screen, and follow-up was encouraged.	Other: Usual Care; Patients randomized to usual care will be informed that they have clinically significant depressive symptoms and will be encouraged to follow-up with their primary care physicians, who will receive a letter from our team indicating that their patient has elevated depressive symptoms and was randomized to the control condition. The letter will also encourage physicians to follow-up with their patients and will provide a list of local mental health services. Like those in the intervention group, usual care patients will continue to have access to and will receive any medical and mental health services that are part of usual care in the targeted health care systems. Thus, there are no restrictions regarding the care that these patients can receive.; Other Names: Treatment As Usual (TAU)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Treatment Brachial Flow-Mediated Dilation (FMD) Adjusted for Pre-Treatment FMD	Patients will undergo ultrasound assessment of brachial FMD in accordance with established guidelines. After a 10-minute supine rest, high-resolution baseline images of the brachial artery will be obtained from 3 consecutive cardiac cycles. Next, the forearm cuff will be inflated to 250 mmHg for 5 minutes and then will be rapidly deflated. At 60 and 90 seconds post-deflation, images from 3 consecutive cardiac cycles will be acquired. FMD values will be computed as the % change in brachial diameter at either 60 or 90 seconds after cuff deflation.	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Treatment Depressive Symptoms Severity (SCL-20 Score) Adjusted for Pre-Treatment SCL-20 Score	Self-reported depressive symptom severity was measured at pre- (0 weeks) and post- (12 weeks) treatment visits by the 20 depression items from the Symptom Checklist 90 (Hopkins Symptom Checklist depression scale; SCL-20). Each item on the scale ranges from 0 (not at all) to 4 (extremely). Total scores are the average across all response items and range from 0 to 4 with higher scores indicating greater levels of depressive symptoms.	12 Weeks
Post-Treatment C-reactive Protein (CRP) Adjusted for Pre-Treatment CRP	A marker of systemic inflammation measured from blood samples collected at pre- and post-treatment.	12 weeks
Post-Treatment Interleukin-6 (IL-6) Adjusted for Pre-Treatment IL-6	A marker of systemic inflammation measured from blood samples collected at pre- and post-treatment.	12 weeks

Collaborators and Investigators

• Sponsor: Indiana University
• Collaborators: American Heart Association
• Investigators: Principal Investigator: Jesse C. Stewart, Ph.D., Indiana University-Purdue Univerisity Indianapolis

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: May 9, 2012
• First Submitted That Met QC Criteria: May 21, 2012
• First Posted (Estimate): May 25, 2012

Study Record Updates

• Last Update Posted (Estimate): December 29, 2022
• Last Update Submitted That Met QC Criteria: November 27, 2022
• Last Verified: November 1, 2022

More Information

Terms related to this study

• Keywords: Depression; Heart Disease; Depressive Symptoms; Cardiovascular Disease (CVD); Coronary Artery Disease (CAD)
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Vascular Diseases; Mood Disorders; Arteriosclerosis; Arterial Occlusive Diseases; Heart Diseases; Depression; Depressive Disorder; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Cardiovascular Diseases
• Other Study ID Numbers: 1105005448; CRP4880000 (Other Grant/Funding Number: American Heart Association); 1703 (Other Identifier: Indiana Clinical Research Center)