In Brief

For psychologists, the link between stress and health isn't new. Yet clear evidence of financial savings has been difficult to show, until now. A study conducted by researchers at Duke University Medical Center and APA has found that cardiac patients who are taught to manage their stress enjoy better health at less cost than patients who participate in an exercise program or those given typical heart care.

The study, published in the Jan. 15 issue of The American Journal of Cardiology, followed 94 men for five years. The patients were divided into three groups: One group attended a four-month aerobic exercise program; the second group participated in a weekly psychological stress-management intervention for the same time period; and the control group received typical care for cardiac patients--medications and regular visits to doctors. The researchers checked in with patients each year to record additional cardiac events and measure costs of overall care.

"The patients who participated in stress management maintained their advantage with respect to fewer clinical events over the five-year follow-up period compared with those patients who just received routine medical care--and they had a significant net savings compared with those in routine medical care," says Duke psychologist and the study's lead author, James Blumenthal, PhD.

Financial benefits were found in the first year of the study. Average costs for patients who were taught stress management were $1,228 per patient, compared with $2,352 per patient in the exercise group and $4,523 per patient for those in the control group.

"In contrast to many studies before, this analysis found that within the first year, health-care costs came down [with the psychological intervention]," says Russ Newman, PhD, JD, APA's executive director for practice. "It's always been thought that it takes time before there's a 'return on an investment' like this. This takes away one argument of the business community about cost offset. The savings are immediate."

After five years, the news is even better: Members of the stress-management group averaged only 0.8 additional cardiac events--angioplasty, heart attack, bypass surgery or death--each, compared with 1.3 for the control group, which received usual care. The exercise group also experienced more cardiac events and higher costs per member than the stress management group, but statistically, the differences were minimal.

And when dollars were added up after five years, the stress management group averaged expenses of $9,251 each compared with $14,997 for each member of the control group and $15,688 for those in the exercise group.

The APA Practice Directorate plans to follow up on this study by conducting another demonstration project. "We're looking for a strategic partner to replicate the results--perhaps an employer for whom cardiovascular disease is a problem," adds Geoffrey M. Reed, PhD, one the study's authors and associate executive director for professional development in APA's Practice Directorate.

"These data really validate what many psychologists already believe--that the psychological interventions they offer are beneficial, not just in terms of quality of life but with proven medical outcomes," says Blumenthal, who is also president of APA's Div. 38 (Health).

--J. DAW