Impact of Stress Management Training on Anxiety and Depression in Cardiopulmonary Rehabilitation Patients
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Authors
Eggers, Sierra
Issue Date
2025
Type
Thesis
Language
en_US
Keywords
Alternative Title
Description/Abstract
Background: Patients with cardiac or pulmonary diagnoses are frequently referred to outpatient cardiopulmonary rehabilitation to improve clinical outcomes. With the American Heart Association elevating depression as a risk factor for cardiac disease along with anxiety and depression being common comorbidities for cardiac and pulmonary disease, cardiopulmonary rehabs have the distinctive opportunity to employ psychosocial interventions to improve mental health outcomes (Quindry et al., 2023). Purpose: This quality improvement project aimed to determine if participation in a stress management class improved PHQ-9 and GAD-7 scores in patients who attended phase II cardiopulmonary rehabilitation. Methods: Following screening for anxiety and depression, all patients participating in rehabilitation were encouraged to attend a stress management class offered six times over a three month-period. Data was collected and analyzed to evaluate pre- and post-PHQ-9 and GAD-7 survey results. A paired t-test was performed to determine if there was a statistically significant change in scores. Results: The primary diagnosis for most patients was related to cardiac disease (n = 35, 92.11%). Less than half of the patients 47.37% (n=18) attended one stress management class. 23.68% (n=9) had a history of depression, and 23.68% (n=9) had a history of anxiety, however, only 18.42% (n=7) of patients reported seeing a mental health provider. PHQ-9 scores decreased regardless of attendance, but those who attended had a larger decrease in average score from 7.67 (SD=6.23) to 3.94 (SD=4.36). GAD-7 scores decreased for those who attended a stress management class from 4.72 (SD=4.65) to 2.56 (SD=3.43), while those who did not attend saw an increase from 2.10 (SD=3.67) to 2.55 (SD=3.75). Recommendations and Conclusion: To align with AACVPR recommendations, cardiopulmonary rehabs should strive to improve psychosocial screening and education. Although stress management education did not appear to improve PHQ-9 and GAD-7 scores more than those who did not attend, those who attended stated that they didn’t realize the extent mental health impacted their physical health and many tried the techniques discussed including journaling and meditation. Moving forward, organizations should improve staffing and resources allocated to cardiopulmonary rehabs and investigate how to improve pulmonary patient recruitment to rehab and education.