Professor Brian Oldenburg1
Professor David Hare2
Professor C. Barr Taylor3
Professor Bruce Hollingsworth1
Dr Kristy Sanderson4
Assistant Professor Anna Hawkes5
Assistant Professor John Atherton6
Professor Michael Jelinek7
1 Monash University
2 Austin Hospital, Melbourne Senior Investigator
3 Stanford University, USA Senior Investigator
4 Menzies Centre, Tasmania Senior Investigator
5 Queensland University of Technology, Queensland
6 Royal Brisbane Hospital, Queensland
7 St. Vincent’s Hospital, Melbourne
Project completion year
This project aimed to implement and evaluate the impact of a telephone-delivered counselling program (MoodCare) to improve mood, quality of life and lifestyle behaviours in depressed patients following a heart attack.
Participants were aged between 21 to 85 years of age, with a clinical diagnosis of a heart attack or unstable angina admitted to six large hospitals in Brisbane and Melbourne. They all had the ability to understand and provide written informed consent in English, had access to a telephone during the program period and were identified as having mild/moderate depression when screened using the Patient Health Questionnaire (PHQ9).
Over a three-year period, 3,071 patients were screened for depression. Participants were recruited in hospital and followed up for baseline data collection once discharged. A research assistant based at Monash University conducted baseline, six-, and 12-month follow-up assessments. Eligible participants were randomly assigned to the Usual Care or the Intervention group after baseline assessment.
Participants in the Intervention group received the MoodCare program, which consisted of 10 telephone counselling sessions delivered by registered psychologists. The program used Cognitive Behaviour Therapy for the management of depression, along with modification of lifestyle behaviours that included physical inactivity and sedentariness, eating a healthier diet, quitting smoking and taking medication as prescribed (consistent with Heart Foundation of Australia guidelines following a heart attack). The program was implemented with the aim of reducing depression as well as to improving lifestyle behaviours and overall quality of life.
The program was conducted over a six-month period and included telephone-delivered sessions by a registered psychologist referred to as the ‘MoodCare Counsellor’ and a participant handbook titled ‘MoodCare Handbook’.
Counsellors taught the specific skills of relaxation, assertiveness, goal setting and sleep improvement, where necessary. Participants received up to 10 telephone sessions over a six-month period. Sessions included eight biweekly or fortnightly calls, and two monthly weekly calls towards the end of the intervention to promote maintenance of behaviour change. Participants in the Usual Care group continued to receive support through their usual health care providers.
121 participants from six hospital sites (Austin Hospital, Royal Melbourne Hospital, Geelong Hospital and St. Vincent’s Hospital in Victoria, Royal Brisbane Women’s Hospital and Prince Charles Hospital in Queensland) participated in the MoodCare study. To assess feasibility and acceptability, data was used from the participant questionnaires.
Evaluation of the feasibility and acceptability of the MoodCare program
More than 60 per cent of intervention participants completed the MoodCare program successfully. The average number of sessions completed per participant was eight and the average length of each session was 48.4 minutes. 85 per cent of participants stated that, overall, they were satisfied with the quality of the MoodCare program and the program provided them with adequate support. 84 per cent of participants stated that the MoodCare program helped them to deal effectively with their problems and that the MoodCare program met their needs. 85 per cent of participants stated that the program helped them reach their goals. 100 per cent of the participants stated that the counsellor worked well with them and that the counselling sessions times were flexible. 77 per cent of participants stated that travel was a barrier to attending face-to-face counselling sessions, while 92 per cent stated that using the telephone for counselling was convenient.
Evaluation of the implementation of the program
Consistent with the study intervention protocol, depression, cognitive therapy, anxiety and behavioural activation were the most frequently covered topics. This was also supported by a very high (90 per cent) fidelity rate (correspondence between Intervention Session Overview and actual sessions).
Assessment of fidelity of the intervention was done by reviews of the counselling sessions, which showed that 89 per cent of relevant items (mood, lifestyle factors and useful skills comprising of sleep, communication, relaxation and goal setting) were completed in all delivered sessions.
Participant adherence was assessed by:
- proportion of sessions completed during the intervention period (80 per cent)
- topics covered in each session (89 per cent)
- total length of intervention exposure during the 6 month period (average 384 minutes).
Although the participants who received the MoodCare program already demonstrated some improvement in mood, quality of life and lifestyle behaviours after six months of receiving the program, the findings are not conclusive because the 12 month data collection is still to be completed. More formal comparisons between the two groups (MoodCare and Usual Care group) can be undertaken once the 12 month data is analysed.
The MoodCare program has been effectively delivered according to the study protocol and well received by participants. This counselling program may be used to assist and support depressed patients who have limited access to psychologists due to distance and time barriers. The protocols developed to ensure fidelity between the intervention protocol and actual sessions have been successfully implemented and could be used for ensuring quality assurance if the program is translated to other clinical settings. More comprehensive evidence concerning the extent to which the program improves mood and lifestyle behaviour will be available during the first half of 2013. However, in summary, the preliminary findings justify the conduct of a larger study to establish the long-term effectiveness of the MoodCare program.
Edwards S, Taylor CB, Whetton J, O’Neil A, Hawkes A, Chan B, Sanderson K, Hare DL, Atherton J, Oldenburg B. Telephone delivered treatment for depression after Acute Coronary Syndrome: Development and implementation of the MoodCare Program. BMC Psychiatry. (Under review)
Dr O’Neil A, Dr Cyril S, Ms Chan B, Sanderson K, Oldenburg B. Effectiveness of a telephone-delivered, depression management and coronary heart disease secondary prevention program for acute coronary syndrome patients (MoodCare) at 6 months: A randomised controlled trial (Under preparation)
Dr Cyril S, Dr O’Neil A, Hawkes A, Ms Chan B, Sanderson K, Oldenburg B Predictors of improvement in mood and lifestyle behaviour following telephone counselling in Acute Coronary Syndrome patients with depression (under preparation)