The Advisory Brought to Practice Routine Screening on Depression (and Anxiety) in Coronary Heart Disease; Consequences and Implications

Abstract

The advisory brought to practice; routine screening on depression (and anxiety) in coronary heart disease; Consequences and implications Luttik, M.L.; Jaarsma, T.; Sanderman, R.; Fleer, J. Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Luttik, M. L., Jaarsma, T., Sanderman, R., & Fleer, J. (2011). The advisory brought to practice; routine screening on depression (and anxiety) in coronary heart disease; Consequences and implications. European Journal of Cardiovascular Nursing, 10(4), 228-233. CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Abstract Introduction: Following the evidence, the American Heart Association recently published a Science Advisory with the recommendation that patients with Coronary Heart Disease (CHD) should be screened for depressive symptoms and depression. Also the Heart Failure Guidelines recommend routine screening for depressive symptoms. Screening for anxiety was not included in these recommendations, despite findings in literature suggesting that cardiac patients are at risk for high levels of anxiety.Objective: The aim of the current study is to obtain a realistic estimation of the consequences and implications of this advice for clinical practice.Method: Data on anxiety, and depression, need for help, demographics and disease related variables were collected in a cross-sectional study within a 2-month period (July-August 2008) at the cardiac outpatient clinic of the University Medical Center Groningen (The Netherlands). Patients: Data of 217 patients were analyzed, mean age was 58 years (± 16) and 62% of the respondents were male. Results: Of 217 patients, 26% indicated to have depressive symptoms and 42% indicated elevated levels of anxiety. About 35-50% of these patients indicated a moderate to high need for help. The prevalence of anxiety and depression was mainly associated with demographic factors and the occurrence of stressful life events. Conclusion: Routine screening will put an increased demand on psychosocial diagnostics and treatment, therefore the availability of professionals should be guaranteed in advance.

Personality disorders in heart failure patients requiring psychiatric management: Comorbidity detections from a routine depression and anxiety screening protocol

“…Consistent with a previous report these findings suggest that implementation of routine screening results in a number of psychiatric comorbidities (Luttik et al, 2011), with personality disorders notably among the highest users of mental health services (Callaly et al, 2011). The findings of extensive psychiatric comorbidity correspond to crosssectional studies among CVD outpatients (Haworth et al, 2005;Holzapfel et al, 2007;Luttik et al, 2011).…”

“…Not surprisingly, personality disorder was associated with psychiatric comorbidity including major depression, generalized anxiety, social phobia and alcohol abuse/dependence (RRs 3.2-3.9) similar to findings reported in other populations primarily free from heart diseases (Friborg et al, 2013). Extending beyond previous reports of routine screening (Annunziato et al, 2008;Caro et al, 2012;Holzapfel et al, 2007;Luttik et al, 2011;Shemesh et al, 2009;Smolderen et al, 2011), these findings have clear clinical implications given the strong associations between personality disorders and other psychiatric comorbidity, even by comparison to positive screen and presumably distressed patients.…”

“…The findings of extensive psychiatric comorbidity correspond to crosssectional studies among CVD outpatients (Haworth et al, 2005;Holzapfel et al, 2007;Luttik et al, 2011). Although specialist mental health training in personality disorder assessment and management would be prudent (Luttik et al, 2011) it is unknown whether this is feasible in CVD settings, nor whether organizational systems can support such initiatives (Hermens et al, 2011). A previous study however showed that placement of a psychiatrist in cardiology wards can improve referral rates (Annunziato et al, 2008).…”

Time-course of depressive symptoms in patients with heart failure

“…Assessing the psychological status of patients regularly, instead of only once in an outpatient setting or primary care setting, may therefore be an important strategy to identify HF patients who remain chronically depressed or who develop depression. However, before implementation of routine screening of depressive symptoms into clinical practice, establishment of treatment programs for approaching depressive symptoms in patients with HF and other cardiac diseases are needed [27].…”

Effect of hand reflexology on anxiety and physiological variables among patients hospitalized in the cardiac care unit: A randomized placebo controlled clinical trial

“…[2] It is believed that more than 42% of patients with cardiac diseases, 50% of patients with acute coronary syndrome (ACS) and 63% of patients with heart failure experience anxiety. [3] Anxiety influences the functions of all body parts and can increase the risk of a subsequent heart attack. Anxiety has negative effects on patients with ischemic heart diseases.…”