The purpose of this study is to determine the effectiveness of a group cognitive-behavioral treatment to modify coronary-prone behaviors in patients from a fairly low social and educational level. Participants were 98 male coronary patients randomly allocated to one experimental and two control groups. All groups received standard medical treatment. The experimental group received an additional psychological treatment and one of the two control groups received a health education treatment. Results showed that only the psychological treatment group significantly reduced Pressured Drive and Speed-Impatience after treatment, and at 1- and 2-year follow-ups. Depression was also significantly reduced only in this group at 2-year follow-up. The results are considered a reliable first step in the process of validating this program designed to improve coronary heart disease patients' quality of life.

The objective of this study was, firstly, to determine the factor structure and factor invariance of the Zung Self-Rating Depression Scale (ZSDS) and, secondly, to justify its use in coronary patients (CPs) and healthy people (HP). Two comparable samples of males were studied: 217 CPs and 191 HP. Exploratory and confirmatory factor analyses (EFA and CFA) for ordinal data were carried out with Mplus. Two models obtained from all participants in this study and another two, the model of Shafer (2006) from a meta-analysis and that of Barefoot et al. (2000) with CPs, were analyzed in CFA. A two-factor structure was supported by EFA in both samples, but none of the models showed adequate goodness-of-fit for the CPs and the HP in CFA. Only the two and three-factor models obtained from the combined sample of CPs and HP showed adequate goodness-of-fit for HP. The ZSDS showed good reliability, replicated the prevalence of depressive symptoms found in other studies and was able to distinguish between CPs and HP. We conclude that the best fit is obtained from the two-factor solution in HP, that the factor structure of the ZSDS is not invariant and is linked to positively and negatively worded items.