University of South Florida, FL 33612, United States.
Int J Nurs Stud. 2011 Jan;48(1):3-12. doi: 10.1016/j.ijnurstu.2010.06.005. Epub 2010 Jul 7.
Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence.
To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD.
A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time.
Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446)=4.42, p=.013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446)=2.00, p=.137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223)=50.34, p<.001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223)=19.25, p<.001).
This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.
抑郁症与冠心病（CHD）同时发生。抑郁症也可能通过降低依从性来抑制心脏康复（CR）计划的有效性。女性中更高的抑郁症患病率可能使她们更有可能不遵医嘱。
评估一种改良的、基于阶段变化匹配的、针对女性的 CR 计划，以减少 CHD 女性的抑郁症状。
一项两组成组随机临床试验比较了传统 12 周 CR 计划中女性的抑郁症状与接受基于行为变化跨理论模型的动机访谈指导的量身定制计划的女性的抑郁症状。实验组的女性还参加了一项排除男性的针对女性的锻炼方案。在基线、干预后和 6 个月随访时，使用流行病学研究中心抑郁量表（CES-D）对 225 名女性进行评估。方差分析用于比较随时间变化的抑郁评分变化。
量身定制组和传统组的基线 CES-D 评分分别为 17.3 和 16.5。干预后的平均分数分别为 11.0 和 14.3；6 个月随访时的分数分别为 13.0 和 15.2。CES-D 评分存在显著的组间时间交互作用（F(2, 446)=4.42, p=.013）。随访测试显示，传统组的 CES-D 评分在随访期间没有差异（F(2, 446)=2.00, p=.137）。相比之下，量身定制组从基线到后测 CES-D 评分显著降低（F(1, 223)=50.34, p<.001）；尽管后测到 6 个月随访期间略有上升，但 CES-D 评分仍低于基线（F(1, 223)=19.25, p<.001）。
与传统计划相比，这项研究表明，改良的、针对女性的 CR 计划可降低女性的抑郁症状。在某种程度上，抑郁会阻碍 CR 的依从性，因此，这种量身定制的计划通过最大限度地提高依从性，有可能改善女性的结局。未来的研究应探讨此类计划产生益处的机制。
