Screening for depression in coronary heart disease: Detection of early disease states

There is a high prevalence of depression in patients with coronary heart disease (CHD) that is often undetected. Around 15 % of patients are diagnosed with major depressive disorder (MDD) after acute myocardial infarction (AMI) or coronary artery bypass grafts (CABG), and 22 % of patients with congestive heart failure (CHF) have MDD. Rates of depression are higher in patients with CHF who are admitted to hospital. Screening aims to identify disease in the community early, enabling early intervention to reduce suffering. Screening programmes for depression in patients with cardiovascular disease (CVD) exist in a number of countries around the world. There is good evidence to suggest that screening programmes increase rates of diagnosis of depression. However, while rates of diagnosis are increased, there is limited evidence to show that patients diagnosed with depression through screening have improved outcomes. Given the evidence available, screening for depression in patients with cardiovascular disease should be cautiously supported when appropriate referral and treatment pathways are in place. There are a number of screening tools that can be used to screen patients for depression. Clinicians should use the Patient Health Questionnaire-9 (PHQ-9) to screen patients for depression, as this is recommended by international guidelines. If time pressure is an issue, the shorter Patient Health Questionnaire-2 (PHQ-2) can be used followed by the PHQ-9 if the PHQ-2 is positive.