Detection of depression in cardiac inpatients: Feasibility and results of systematic screening

Harvard Medical School, Boston, MA, USA.
American heart journal (Impact Factor: 4.46). 05/2010; 159(5):780-7. DOI: 10.1016/j.ahj.2010.02.029
Source: PubMed


A recent American Heart Association (AHA) Prevention Committee report recommended depression screening of all coronary heart disease patients using 2- and 9-item instruments from the Patient Health Questionnaire (PHQ-2 and PHQ-9) to identify patients who may need further assessment and treatment. Our objective was to assess the feasibility and results of such screening on inpatient cardiac units.
In September 2007, the PHQ-2 was added to the nursing interview dataset on 3 cardiac units in a general hospital; this screen was completed as part of routine clinical care. Rates and results of depression screening, reasons for patients not being screened, and results of a nursing satisfaction survey were tabulated, and differences in baseline characteristics between screened and unscreened patients were analyzed via chi(2) and independent-samples t tests.
For a 12-month period, 4,783 patients were admitted to the cardiac units; 3,504 (73.3%) received PHQ-2 depression screening. Approximately 9% of screened patients had a PHQ-2 score > or =3 and were approached for further depression evaluation (PHQ-9) by a social worker; 74.1% of the positive-screen patients had a PHQ-9 score of > or =10, suggestive of major depression. Nurses (n = 66) reported high satisfaction with the screening process, and mean reported PHQ-2 screening time was 1.4 (+/-1.1) minutes.
Systematic depression screening of cardiac patients using methods outlined by the AHA Prevention Committee is feasible, well-accepted, and does not appear markedly resource-intensive. Future studies should link these methods to an efficient and effective program of depression management in this vulnerable population.

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    • "One study of this two-step screening method found relatively high rates of completion and high staff satisfaction among patients hospitalized on inpatient cardiac units. However, in this case, the PHQ-2 screening was performed by clinical nurses as part of routine care, while the follow-up PHQ-9 was performed by a study social worker [161]. A more complete clinical implementation of the two-step screening resulted in substantial detection of depression in screened patients but only modestly improved overall recognition of depression due to a significant minority of patients who did not get screened; clinical staff reported preference for a single-stage screen instead [162]. "
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    ABSTRACT: In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities-may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
    Full-text · Article · Apr 2013 · Cardiovascular Psychiatry and Neurology
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    • "Furthermore, we evaluated the predictors of a positive depression screen at the time of admission to the hospital; prior studies of depression risk factors in cardiac patients have focused on correlates of depression at the time of discharge or following hospitalization [4] [38]. Depression screening at admission flows well as part of the overall intake process, and we have found that such screening is well-accepted by patients and staff and not substantially resource-intensive [13]. Limitations include the fact that this study was performed in a single academic medical center, with a largely Caucasian population . "
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    ABSTRACT: Depression is common in patients with cardiac illness and is independently associated with elevated morbidity and mortality. There are screening guidelines for depression in cardiac patients, but the feasibility and cost-effectiveness of screening all cardiac patients is controversial. This process may be improved if a subset of cardiac patients at high risk for depression could be identified using information readily available to clinicians and screened. To identify risk factors for a positive depression screen at the time of admission in hospitalized cardiac patients. A total of 561 consecutively screened cardiac inpatients underwent the Patient Health Questionnaire-2 (PHQ-2). A prospective chart review was performed to assess potential risk factors for depression that would be readily available to front-line clinicians. Rates of risk factors were compared between patients with positive and negative PHQ-2 depression screens, and multivariate logistic regression was performed to assess whether specific risk factors were independently associated with positive screens. Of the 561 patients screened, 13.5% (n=76) had a positive depression screen (PHQ-2≥2). In the univariate analyses, several variables were associated with a positive depression screen. On multivariate analysis, an elevated white blood cell (WBC) count (>10×10(9) cells per liter) and prescription of an antidepressant on admission were independently associated with a positive depression screen, while current smoking showed a trend toward significance. Information on these three identified risk factors (WBC count, antidepressant use, and smoking) is readily available to clinicians, and patients with these diagnoses may represent a cohort who would benefit from targeted depression screening in certain settings.
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