Experts say heart patients should be screened for depression

Sep 30 2008

The American Heart Association says heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery and overall health.

A report by researchers at Yale School of Public Health says depression and heart disease appear to be very much intertwined and the heart cannot be treated in isolation from the patient's mental health.

Dr. Judith H. Lichtman, co-author of the report who is an associate professor of epidemiology at Yale, says by understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, an understanding can be gained into the best ways to recognize and treat it.

The statement is the first of its kind on the link between heart disease and depression and it has the endorsement of the American Psychiatric Association and it recommends: -

• Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician's office and cardiac rehabilitation center.

• Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.

• Careful monitoring of patients to ensure adherence to their treatment plan.

• Coordination between health care professionals treating patients with combined medical and mental health diagnoses.

The researchers say while there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life.

It seems that depression is about three times more common in people with heart complications than in the general population and as many as 20% of heart patients meet the criteria for major depression.

Research suggests that younger women in particular may be at high risk and it is recommended that heart patients initially be evaluated with a simple two-item assessment and if even one of the questions generates a "yes" response, it is recommended that a more in-depth screening be done with a total of nine questions.

Heart patients found to be suffering from depression can benefit from a number of treatment options, including behavioural therapy, physical activity, cardiac rehabilitation, antidepressant drugs, or combinations of these treatments.