Risk factors

Cardiologists rarely screen for depression

Australian cardiologists rarely screen patients for depression, believing it is the GP’s role to identify and treat cardiac patients for mood disorders, a national study shows.

Only 3% of cardiologist routinely use validated depression screening instruments in their patients, a survey of 524 CSANZ members has revealed.

The study, led by Dr David Hare of the Department of Cardiology, Austin Health, Victoria, found that most cardiologists do not routinely ask patients about depression, with only 29% saying they asked their patients “quite often” and 50% “sometimes” about feeling down.

Two thirds of cardiologists (64%) said they felt confident to identify depression in their patients and 71% said they would be willing to screen patients if a brief screening questionnaire was available.

However,  most cardiologists (79%) ranked GPs as primarily responsible for identifying depression in cardiovascular patients.

Likewise, most rarely (25%) or only sometimes (43%) referred their depressed patients for treatment. Three quarters of cardiologists did not feel very confident about treating depression and 63% believed GPs should be primarily responsible for treatment of depression.

Cardiologists who understood the prognostic risks of depression in cardiovascular disease were more likely to screen their patients, and those who screened patients were also more likely to refer patients or treat them with SSRIs.

Writing in Heart, Lung and Circulation, Dr Hare said the findings showed that despite routine depression screening being endorsed as good clinical practice in guideline recommendations, most cardiologists did not feel confident about doing this.

“Efforts to increase cardiologists’ awareness of the psychosocial issues, and depression in particular, in their cardiovascular disease patients, appears worthwhile, as does improving access to brief, validated screening instruments,” they wrote.

They suggested that simple questionnaires such as the cardiology-validated five-item ‘Depression Scale – Short Form’ could be completed by patients in the waiting room.

“Alternatively, the cardiologist can screen for depression by asking two separate questions related to major depression: feeling down/depressed and reporting lack of interest/pleasure,” they added.

Greater awareness of the psychosocial impacts of depression on patients’ quality of life, adherence to medication and prognosis may also help overcome the low levels of referall for treatment, they said.

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