Table 2. Study characteristics and findings.

First author (year)	Design, follow-up time	Sample	Measurement of depression	Treatment	Control	Results
Cardiovascular Disease
ENRICHD14 (2003)	RCT 2 arms 30 months	N = 2481 28 days post-MI Eligible if classified as depressed or low perceived social support Females 44% Minorities 34%	DISH, BDI, HRSD	11 tailored CT sessions over 6 months, group therapy as needed, referral to psychiatry for antidepressants as needed	Usual care; physicians were notified if patients were depressed or had low perceived social support	The CT group had a lower BDI score compared to control (9.1 vs. 12.2, p <.001), and a lower HRSD score (7.6 vs. 9.4, p <.001) at 6 months. This difference was not present at 30 or 42 months
Freedland (2009)17	RCT 3 arms 9 months	N = 123 CABG surgery within the past year Eligible if scored ≥ 10 on the BDI and met DSM-IV criteria for major or minor depression based on the DISH Females 50% Minorities 19%	HRSD score derived from the DISH; BDI	1. CT: 12 weekly, individual, 50-60 minute sessions with a therapist 2. Supportive stress management: 12 weekly, individual, 50-60 minute session. Training included progressive relaxation, imagery, and controlled breathing	Usual care	Patients in the CT and stress management group were more likely to experience remission from depression at 3, 6, and 9 months compared to patients in the usual care group
Burgess18 (1987)	RCT 2 arms 13 months	N = 180 Post acute MI Females 14% Minorities not reported	ZDS	A mean of 6.32 CT visits per patient, social support, facilitation of job return	Usual care	There were no differences between groups on depression scores at baseline or follow-up
Cowan19, 20 (2001)	RCT 2 arms 3 months	N = 133 Sudden cardiac death survivors Females 27% Minorities 10%	SCR-90: Depression subscale	11 sessions of combined CT, biofeedback, and health education, administered biweekly for six weeks	90 minute health education class	Depressive symptoms decreased in the treatment group when compared to the control group
Black21 (1998)	RCT 2 arms 6 months	N = 60 Recently hospitalized for angina, MI, angioplasty, or CABG Eligible if scored as distressed Females 12% Minorities not reported	SCR-90: Depression subscale	1 to 7 weekly sessions with a psychologist including: relaxation training, stress management, reduction of risk factors, efforts to improve adherence, and CT intervention; antidepressants if necessary	Cardiac rehabilitation with monitored exercise 1-3 times per week, for 8 weeks, daily home exercise. Education on stress management, support group meeting with spouses, individual nutrition counseling	The CT group had significant reductions in depressive symptoms compared to the control group (-5.2 vs. -0.2, p < .034)
Frizelle22 (2004)	RCT 2 arms 3 months	N = 22 Patients with ICD's Females not reported Minorities not reported	HADS	Group-based therapy, six sessions, 1 hour each: home-based exercise, education, relaxation, behavioral goal setting, education on identifying and challenging negative thoughts	Wait list	The treatment group experienced decreases in depressive symptoms compared to the control group (-4.25 vs. -0.2, p = .001)
Kohn23 (2000)	RCT 2 arms 9 months	N = 49 Post-ICD implantation Females 35% African American 8%	BDI version II; 4 biological measures of depression: sexual functioning, appetite, weight change, and sleep patterns	9 sessions ranging from 15-90 minutes, sessions included psycho-education on: anxieties about ICD, avoidance behavior, fear of shocks, stress management, work and social activities, distorted cognitions	Usual care	The CT group had lower levels of depressive symptoms at follow-up compared to the control group (6.9 vs. 15, p = .037), but depressive symptoms were not measured at baseline
Lewin24 (2007)	Clustered RCT 2 arms 6 months	N = 192 Patients undergoing ICD implantation 8 implantation centers in the UK were randomized to intervention or control Females 20% Minorities 3%	HADS-Depression subscale	Intervention consisted of 2 booklets for patients, 1 booklet for family, a goal-setting diary and a relaxation tape. The first booklet targeted fears prior to ICD implantation. The second booklet consisted of a self-help CT program. The intervention was delivered by healthcare staff that underwent a half day of training.	Usual care and contact by a study facilitator to discuss postoperative progress	The intervention group experienced a greater reduction in the proportion of patients with depression at six months compared to the control group (-13.2% vs. -2.1%, p value not reported)
Kostis25 (1994)	RCT 3 arms 3 months	N = 20 Patients with congestive heart failure Female 30% Minorities not reported	BDI	12 weeks of exercise training at a cardiac rehab facility for 1 hr 3 times per week; weekly meetings with a dietician; group-based CT intervention: twice weekly for 60-90 minutes (relaxation, positive imagery, appraisal of negative cognitions)	1. Lanoxin titrated to achieve levels between 0.8-2.0 ng/mL 2. Placebo	There was a 52% decrease in BDI scores in the intervention group compared to a 15% and 25% increase in the control groups at follow up (p = .04)
Stroke
Lincoln26 (2003)	RCT 3 arms 6 months	N = 123 1 to 6 months post-stroke Eligible if scored as depressed Female 49% Minorities not reported	BDI WDI	Ten 1-hour sessions over 3 months, tailored CT intervention: education, task assignment, activity scheduling, identification and modification of inaccurate thoughts	1. No intervention 2. Attention placebo: Ten 1 hr visits over 3 months	No significant differences between groups in depression scores
Diabetes
Lustman27 (1998)	RCT 2 arms 6 months	N = 51 Type II diabetes and major depression Females 60% Minorities 19%	DIS BDI	1 hour per week of individual CT for 10 weeks, strategies included: behavioral strategies, problem solving, and cognitive techniques to change cognitive errors	Attention placebo: 1 hour, biweekly, individual sessions with a diabetes educator	The CT group had a higher rate of remission from depression compared to the control group (58.3% vs. 25.9%, p = .03)
Snoek28 (2008)	RCT 2 arms 12 months	N = 86 Adults with poorly controlled type I diabetes Females 58% Minorities: not reported	CES-D	6 weekly group sessions of CT delivered by a diabetes nurse educator and a psychologist. Sessions focused on cognitive restructuring, behavior change and stress management	Blood glucose awareness training focused on symptom management and diabetes education, delivered by a diabetes nurse educator and a psychologist	There were no differences between groups with regard to change in depressive symptoms over time
Henry29 (1997)	RCT 2 arms 7 weeks	N = 19 Type II Diabetes Females 53% Minorities not reported	BDI	Six sessions of 1.5 hours: progressive muscle relaxation, cognitive coping training (such as identifying and modifying negative thoughts), problem-solving skills, homework assignments	Wait-list	Depressive symptoms decreased across time in both groups; there was no difference between groups
Ismail30 (2008)	RCT 3 arms 12 months	N = 344 Adults with poorly controlled type I diabetes Females 60% Minorities 20%	PHQ-9	1. CT plus motivational enhancement: 4 individual sessions of motivational enhancement therapy (see below) and 8 sessions of CT delivered over 6 months by trained diabetes nurses 2. Motivational enhancement: 4 individual sessions delivered over 2 months by a diabetes nurse. Sessions focused on assessment of readiness to change, diabetes behavior modification, and problem solving	Usual care	Neither group experienced an improvement in depressive symptoms compared to usual care

BDI: Beck Depression Inventory version I; CABG: Coronary bypass graft surgery; CT: Cognitive Therapy; DIS: Diagnostic Interview Schedule; DISH: Depression Interview and Structured Hamilton; HADS: Hospital Anxiety & Depression Scale; HRSD: Hamilton Rating Scale for Depression; PHQ-9: Patient Health Questionnaire; SCR-90: Symptom Checklist 90 Revised; WDI: Wakefield Depression Inventory; ZDS: Zung Depression Scale