Screening for depression in patients with chronic heart disease using two brief questions: The take heart in primary care study cohort

Abstract

Background: Despite, a strong and consistent association between depression and chronic heart disease (CHD), depression is frequently undiagnosed and untreated. GPs find many case-finding screening questionnaires for depression cumbersome and time consuming for routine use. Methods: The TAKE-HEART study is a cluster randomised controlled trial in 19 metropolitan general practices in SA testing the hypothesis that a program of screening for depression, academic detailing and tailored psychiatric advice to support GPs can reduce comorbid depression in patients with CHD, relative to usual care during 12 months follow-up. Sensitivity and specificity of two questions (have you been bothered by ‘feeling down, depressed or hopeless?’ or ‘little interest or pleasure in doing things?’ during the past month), compared with the Centre for Epidemiological Studies Depression scale (CES-D). Results: A total of 284 participants (mean age (SD) 70 years (±10), 35% female) were enrolled in the study. The most common form of CHD was coronary artery disease (angina pectoris: 44%, prior history of acute myocardial infarction: 34%). A further 38% and 20% had atrial fibrillation and heart failure, respectively. The two screening questions showed a sensitivity of 44% (95% confidence interval [CI]: 32% to 55%) and specificity of 95% (95% CI: 90% to 97%). Overall, 15% (43/280) of patients screened positive for depression using both questions versus 27% (77/284) for the CES-D. Conclusion: Further analyses are required to determine the utility of two brief questions for detecting depression in patients with CHD in primary care, given their high specificity but low sensitivity.