Several years ago, the American Heart Association (AHA) made a recommendation to have all individuals with cardiac issues screened for the presence of depressive symptoms. This recommendation was made based on the finding that nearly one in five coronary heart disease (CHD) clients have depression and, therefore, are at risk for poorer physical and mental outcomes.
However, since that recommendation, no analysis has been made to see if screening for depression improves the outcome of these clients’ health. In fact, what scant research exists on this topic is varied and provides inconsistent results. Depression screening is expensive and can add to the already mounting costs of CHD clients. Therefore, Brett D. Thombs of the Department of Psychiatry at McGill University in Canada wanted to determine if, in the several years since the AHA made their recommendation, any consistent evidence existed to support it.
Thombs researched studies involving various methods of depression screening in a cardiac or primary care setting to validate accuracy. He looked at how antidepressant treatment affected not only cardiac treatment and outcomes, but also depressive symptoms and psychological outcomes. Overall, Thombs found only 15 studies that focused on the accuracy of depression screening. Of those, results were highly varied. Some studies showed that nearly one third of all CHD clients showed symptoms of depression, yet not all would reach clinical levels.
Additionally, although the number of clients receiving antidepressants continues to rise, Thombs did not find any research showing across the board efficacy for such treatment. In fact, although some people did see reductions in symptoms with antidepressants, others had the same outcome on placebo. Thombs also found that even though several studies looked at how depression screening affected cardiac outcome, no study looked at how this type of test affected the outcome on depression.
These findings show that to date, evidence is lacking in support of the depression screening recommendation made by the AHA. Concerns surrounding this recommendation include the financial burden to clients and social resources, but more importantly, the overprescription of antidepressants and the risk these medications can have on CHD treatment. Thombs said, “We hope that the AHA will similarly reconsider its recommendation for depression screening of all CHD patients.”
Thombs, B.D., Roseman, M., Coyne, J.C., de Jonge, P., Delisle, V.C., et al. (2013). Does evidence support the American Heart Association’s recommendation to screen patients for depression in cardiovascular care? An Updated Systematic Review. PLoS ONE 8(1): e52654. doi:10.1371/journal.pone.0052654
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