IU-led intervention leveraging technology reduces depression in Indianapolis-area patients

INDIANAPOLIS — The rapid expansion and normalization of e-health and telehealth brought about by the COVID-19 pandemic is not only here to stay, but research conducted by Jesse Stewart, professor of psychology at the School of Science at Indiana University Indianapolis, on the link between depression and cardiovascular disease indicates it’s effective, too. Backed by a $2.6 million grant from the National Heart, Lung, and Blood Institute of the NIH in 2015, Stewart and a team of 14 found the modernized collaborative care intervention they designed had a significant impact on patients. The research, which featured methods of internet and telephonic cognitive-behavioral therapy, was initially intended to discover if treating depression could reduce one’s risk of developing cardiovascular disease.

The research was reported in the journal Brain, Behavior, and Immunity.

Working with their clinical partner Eskenazi Health, Stewart and his team treated 216 primary care patients within a 5-year span. Patients were randomly assigned to one of two groups, eIMPACT intervention or usual primary care. Of those in the eIMPACT intervention group, 43% exhibited at least a 50% reduction in depressive symptoms, compared to only 17% in the usual care group.

“We had the intention of making the intervention more innovative,” Stewart said. “But coming out on the back end, serendipity. We developed, potentially, the next iteration of a collaborative care framework for mental and physical health conditions, and that’s not what we initially set out to do.”

Given the study took place between 2015-2020, before the pandemic’s normalization of e- and telehealth, there was some reluctancy around how this modernized approach would work. After the findings, Stewart’s confident harnessing technology for mental health care is a viable path moving forward.

“When we first started this study, people had reservations about whether technologies, like internet psychotherapy, were feasible or acceptable in a safety net healthcare setting,” he said. “Our study shows it’s not only feasible and acceptable, but it’s effective.”

As for the primary focus of the study, successful treatment of depression alone did not lower cardiovascular disease risk biomarkers, demonstrating alternative approaches are needed.

“We need to treat depression for its own sake, but we also need to fully understand and target the pathways from depression to the development of cardiovascular disease,” Stewart said. “Our eIMPACT trial showed depression treatment alone is not sufficient to bring their risk of cardiovascular disease back down to the general population. So, we need to do more.”

The study is just one of many initiatives Stewart is leading. In 2021, he received a $425,000 grant from the NIH with Dr. Samir Gupta, professor and vice chair for research at the IU School of Medicine, to test whether an internet cognitive-behavioral therapy for insomnia improves insomnia symptoms and reduces systemic inflammation in people with HIV.

Researchers on the eIMPACT trial team were Drs. Christopher Callahan, John Nurnberger, Samir Gupta, Robert Considine, Sujuan Gao, and Richard Kovacs of the IU School of Medicine; Dr. Bruce Rollman of the University of Pittsburgh; Krysha MacDonald of Eskenazi Health; Dr. Jay Patel of the Mayo Clinic; Dr. Brittanny Polanka of the University of Minnesota, Dr. Elizabeth Vrany of Northwell Health, Dr. Jessica Berntson of Dr. Jessica Berntson Inc., Dr. Loretta Hsueh of the University of Illinois at Chicago, and Dr. Aubrey Shell of IU Health Ball Outpatient Behavioral Health. Drs. Patel, Polanka, Vrany, Berntson, Hsueh, and Shell were School of Science graduate students in the Clinical Psychology Ph.D. program. Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the NIH under Award Number R01HL122245. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Research partners of the study include the Indiana CTSI and the Regenstrief Institute.