Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the United States.¹ Its main indications are the relief of angina and improvement in quality of life.² Yet as many as half of post-CABG patients report depressive symptoms in the perioperative period,³ are more likely to experience a decreased health-related quality of life (HRQL) and functional status,⁴ continued chest pains,^5,6 and inreased rates of rehospitalization and death following CABG surgery independent of cardiac status, medical comorbidity, or the extent of surgery.^7-11

Anxiety disorders are prevalent in primary care practice and associated with substantial reductions in health-related quality of life.^1-3 Over 30 million Americans have suffered from an anxiety disorder at some point in their lives, and approximately 12% to 22% of primary care patients present to physicians with symptoms of distress related to anxiety.^4,5 Moreover, they tend to use expensive medical resources such as emergency departments and hospitals at higher rates than the general population.^6-10 The annual direct and indirect costs in the United States associated with anxiety disorders have been estimated at over $42 billion, 10% of which represents indirect workplace costs.¹¹

Dozens of trials have proven the effectiveness of collaborative care strategies at treating mood and anxiety disorders in primary care.¹ These programs typically involve nonphysician care managers who promote use of evidence-based treatment protocols and monitor patients’ clinical response under the supervision of their primary care physicians (PCPs). However, challenges hinder provision of collaborative care into routine practice and at scale.²

Objective Optimism has been associated with a lower risk of rehospitalization after coronary artery bypass graft (CABG) surgery, but little is known about how optimism affects treatment of depression in post-CABG patients. Methods Using data from a collaborative care intervention trial for post-CABG depression, we conducted exploratory post hoc analyses of 284 depressed post-CABG patients (2-week posthospitalization score in the 9-item Patient Health Questionnaire ≥10) and 146 controls without depression who completed the Life Orientation Test – Revised (full scale and subscale) to assess dispositional optimism. We classified patients as optimists and pessimists based on the sample-specific Life Orientation Test – Revised distributions in each cohort (full sample, depressed, nondepressed). For 8 months, we assessed health-related quality of life (using the 36-item Short-Form Health Survey) and mood symptoms (using the Hamilton Rating Scale for Depression [HRS-D]) and adjudicated all-cause rehospitalization. We defined treatment response as a 50% or higher decline in HRS-D score from baseline. Results Compared with pessimists, optimists had lower baseline mean HRS-D scores (8 versus 15, p = .001). Among depressed patients, optimists were more likely to respond to treatment at 8 months (58% versus 27%, odds ratio = 3.02, 95% confidence interval = 1.28–7.13, p = .01), a finding that was not sustained in the intervention group. The optimism subscale, but not the pessimism subscale, predicted treatment response. By 8 months, optimists were less likely to be rehospitalized (odds ratio = 0.54, 95% confidence interval = 0.32–0.93, p = .03). Conclusions Among depressed post-CABG patients, optimists responded to depression treatment at higher rates. Independent of depression, optimists were less likely to be rehospitalized by 8 months after CABG. Further research should explore the impact of optimism on these and other important long-term post-CABG outcomes.

To assist researchers and clinicians in primary care with assessment and treatment of generalized anxiety disorder (GAD), we developed a simple standardized instrument, similar to the Panic Disorder Severity Scale. Independent evaluators used the six‐item Generalized Anxiety Disorder Severity Scale (GADSS) to conduct telephone assessments of 330 patients from four primary care facilities with DSM‐IV diagnoses of GAD and/or panic disorder who were participating in a study of the effectiveness of collaborative care treatment. Participants were also evaluated at a 12‐month follow‐up. Internal consistency, convergent and discriminant validity, and sensitivity to change were determined. The GADSS had high internal consistency, and showed good validity and sensitivity to change. Change in GADSS scores discriminated between two different treatment strategies. GADSS is a simple, efficient way to rate severity over the telephone in patients with established diagnoses of GAD. Depression and Anxiety 23:77–82, 2006.