Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lesperance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 118: 1768-75

Circulation (Impact Factor: 14.95). 10/2008; 118(17):1768-75. DOI: 10.1161/CIRCULATIONAHA.108.190769
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ABSTRACT Depression is commonly present in patients with coronary heart disease (CHD) and is independently associated with increased cardiovascular morbidity and mortality. Screening tests for depressive symptoms should be applied to identify patients who may require further assessment and treatment. This multispecialty consensus document reviews the evidence linking depression with CHD and provides recommendations for healthcare providers for the assessment, referral, and treatment of depression. (Circulation. 2008; 118: 1768-1775.)

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    • "The PHQ-9 (Kroenke et al., 2010) is a nine item depression questionnaire covering major depression disorder criteria demarcated by DSM-IV (American Psychiatric Association, 2000). PHQ scoresZ10 warrant further evaluation according to guidelines (Lichtman et al., 2008) and have favorable sensitivity and specificity for detection of depression disorder in heart disease populations (McManus et al., 2005). Patients also completed an eight item questionnaire regarding anxiety (Generalized Anxiety Disorder-7, seven items (GAD-7); and a one-item panic screener " In the last 4 weeks, have you had an anxiety attack—suddenly feeling fear or panic? "
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    ABSTRACT: Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place.
    Psychiatry Research 09/2014; 220(3):954–959. DOI:10.1016/j.psychres.2014.08.051 · 2.68 Impact Factor
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    • "When depression is linked with CHD, the outcome inevitably increases disease burden. Despite the strength of the link between depression and CHD and guidelines recommending screening for depression in all patients with CHD (Lichtman et al. 2008, National Institute for Health & Clinical Excellence 2010, Colquhoun et al. 2013), routine screening is not a common practice; often the result of an absence of systems to facilitate this process (Ziegelstein et al. 2005, Munson et al. 2007, Ski et al. 2012). Additionally, health care professionals have been found to perceive depression as a 'normal' part of suffering after a cardiac event (Worrall-Carter et al. 2012). "
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    ABSTRACT: Aims and objectivesThe aim of this study was to evaluate nurses' perceptions of an education programme and screening and referral tool designed for cardiac nurses to facilitate depression screening and referral procedures for patients with coronary heart disease.Background There is a high prevalence of depression in patients with coronary heart disease that is often undetected. It is important therefore that nurses working with cardiac patients are equipped with the knowledge and skills to recognise the signs and symptoms of depression and refer appropriately.DesignA qualitative approach with purposive sampling and semi-structural interviews was implemented within the Donabedian ‘Structure-Process-Outcome’ evaluation framework.Methods Semi-structured interviews were conducted with 14 cardiac nurses working in a major metropolitan hospital six weeks post-attending an education programme on depression and coronary heart disease. Thematic data analysis was implemented, specifically adhering to Halcomb and Davidson's (2006) pragmatic data analysis, to examine nurse knowledge and experience of depression assessment and referral in an acute cardiac ward.ResultsThe key findings of this study were that the education programme: (1) increased the knowledge base of nurses working with cardiac patients on comorbid depression and coronary heart disease, and (2) assisted in the identification of depression and the referral of ‘at risk’ patients.Conclusions Emphasis was placed on the translational significance of educating cardiac nurses about depression via the introduction of a depression screening and referral instrument designed specifically for use in the cardiac ward. As a result, participants found they were better equipped to identify depressive symptoms and, guided by the screening instrument, to confidently instigate referral procedures.Relevance to clinical practiceMuch complexity lies in caring for cardiac patients with depression, including issues such as misdiagnosis. Targeted education, including use of appropriate instruments, has the potential to facilitate early recognition of the signs and symptoms of depression in the acute cardiac setting.
    Journal of Clinical Nursing 09/2014; 24(1-2). DOI:10.1111/jocn.12703 · 1.26 Impact Factor
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    • "Given the negative effects of depression on cardiac patients, several clinical guidelines have recommended early screening and evaluation for treatment of depression [10]. In order to efficiently carry out the two-step procedure recommended by the clinical guidelines [10], the choice of a rapid, but accurate, first-step screening tool is crucial. "
    International journal of cardiology 01/2014; 172(2). DOI:10.1016/j.ijcard.2013.12.308 · 6.18 Impact Factor
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