Cognitive behavior therapy or collaborative care for patients with clinical depression after CABG can be beneficial to reduce objective measures of depres- sion.665 669 (Level of Evidence: B) The negative impact of emotional dysfunction on risk of morbidity and mortality after CABG is well recognized. In a multivariate analysis of elderly patients after CABG, the 2 most important predictors of death were a lack of social participation and a lack of religious strength.670 Social isola- tion is associated with increased risk of death in patients with CAD,671 and treatment may improve outcomes.672 The most carefully studied mood disorder, depression, occurs com- monly after CABG. Several studies have shown that the primary predictor of depression after CABG is its presence before CABG and that only rarely does CABG cause depres- sion in patients who were not depressed beforehand. In 1 report, half the patients who were depressed before CABG were not depressed afterward, and only 9% of subjects who were not depressed before CABG developed depression postoperatively.673 The prevalence of depression at 1 year after CABG was 33%, which is similar to the prevalence in those undergoing other major operations. Patients with stron- ger perceptions of control of their illness were less likely to be depressed or anxious after CABG.674 No difference in the incidence of mood disturbances was noted when off-pump and on-pump CABG were compared.675 4.8.1. Effects of Mood Disturbance and Anxiety on CABG Outcomes Depression is an important risk factor for the development and progression of CAD. 