Because previous studies on the effectiveness of psychological treatment for cardiac patients were inconsistent, Linden et al. conducted this meta-analysis of a total of 43 relevant randomized trials. The authors concluded that psychological treatment reduced cardiac patient mortality by 27% over follow-ups of 2 years or less and also reported that event recurrence dropped 43% with a follow-up period longer than 2 years. However, psychological treatment needed to be initiated at least 2 months after the cardiac event to produce a significant benefit in survival. While these findings are consistent with other reviews, this analysis was the first to demonstrate a gender difference. The authors found that women with cardiac disease did not benefit from traditional psychological treatment. Mortality benefits were found only in men and the timing for the initiation of psychological treatment was a critical variable for mortality outcomes. This paper was accompanied by an editorial by Dobbels F. who emphasized the need for prudence in interpreting this meta-analysis. The scientific quality and clinical relevance of the study were not questioned, although the subanalysis showing no mortality benefits in women may have lacked statistical power to draw firm conclusions. Several risk factors have been identified that may help explain women’s greater susceptibility to depressive symptoms. This susceptibility may also explain why women are at increased risk of poor cardiovascular outcomes. The author therefore recommends that specific programs should be developed and tested specifically in women.
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