Aim: To investigate the impact of internet based-cognitive behavioural therapy (I-CBT) on self-care behaviour in HF patients and to study the association between changes in depressive symptoms and changes in self-care behaviour.
Methods: Sub-analysis of data collected in a pilot randomised controlled study evaluating the impact of 9 weeks I-CBT (n=25) on depressive symptoms in HF compared to a moderated on-line discussion forum (ODF) (n=25). The I-CBT program included homework assignments and written feedback by a nurse. In week 2 and 3 the I-CBT program included psychoeducation about HF self-care whereas patients in the ODF could discuss related HF topics and self-care in written. Patient Health Questionnaire- 9 was used to measure depressive symptom at baseline and at 9 weeks follow-up. The European Heart Failure Self-care Behaviour Scale-9 (EHFScBS) (i.e. the summary score and the subscales autonomous based, provider based and consulting behavior) measured self-care behaviour at baseline, 3 weeks and at the 9 weeks follow-up.
Results: As seen in the figure, at three weeks the total self-care score and the scores in three subscales of the EHFScBS had increased in both groups. After 9 weeks all self-care scores in the ODF-group had returned back to baseline levels but in the I-CBT group autonomous-based (weighing, exercise, fluids) and provider-based self-care (medications, diet) remained increased, the latter being statistically significant (p=0.05). A significant correlation between improvement in symptoms of depression and improvement in autonomous-based self-care was found (r=0.34, p=0.03).
Conclusion: Improvement in depressive symptoms was associated with improved autonomous-based self-care. I-CBT for depression in HF may benefit aspects of self-care that are vital to improve survival