Evidence Lacking to Warrant Depression Screening in Cardiac Cases

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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  • clark

    May 13th, 2013 at 11:16 PM

    don’t even know why this was recommended.it works the other way but not this way.depression could lead to heart problems but how does it work the other way?someone sitting and wallowing over heart disease?I dont think so!

  • Nikki

    May 14th, 2013 at 1:20 AM

    Woah u have got to be kidding right? my grandpa. he had a heart attack and he is so depressed now. He doesn’t like to talk about it. But man before he was the best and now he just stay in the bed all day. And watches TV.

  • Bridgette

    May 14th, 2013 at 1:23 AM

    Well, even if you only catch a small percentage, isn’t that worth it? I mean, isn’t how quickly someone heals affected by their mental state? With all the useless things done now just to make money, it seems like this type of screening would be quite important and useful. Just imagine how many people could be benefited. And, not just the patient either. Family members and caregivers would also benefit.

  • Ally K

    May 14th, 2013 at 1:24 AM

    20% seems like a lot to me why not just screen them um hello?

  • Aman

    May 14th, 2013 at 1:28 AM

    Ya, okay, well then if it’s expensive maybe they shouldn’t do it so much

    Which just leads me to this point:

    why in the sam hill is being in the hospital so flipping expensive in this country?

    it is soooooooo out of control

    that someone who is very likely depressed can’t even find out for sure cuz it is so expensive

    this would never happen in other countries like in europe or something.

    there health stuff is sooooooo much better than ours.

    it seriously makes no sense.

  • d.berowski

    May 14th, 2013 at 1:30 AM

    I am seriously not understanding.why depression screening is so expensive.just go to a psychiatrist.and they can tell you quick if you are or not.depressed i mean.insurance will cover that.

  • Olive

    May 14th, 2013 at 1:34 AM

    My sister had a heart attack awhile back. When she got out of the hospital, it took awhile for her to get her strength back. Once she was strong, she was right back to her usual happy self. She has always been very active and loves going out and meeting new people. She still enjoys doing that and everyone who meets her immediately loves her. I guess maybe we were just some of the lucky ones.

  • Penny

    May 14th, 2013 at 1:37 AM

    surprise surprise. Patients getting medicine without needing it just does not surprise me one bit not at all. All these doctors getting paid from the pharmacy companies just looking to make more money. money money money. As soon as people stop being so greedy we can get back to the way things used to be in this country. SMH.

  • Gerry

    May 14th, 2013 at 1:40 AM

    So interesting that there is so little research in this area so anyone who wants to do more research into it can i’ll have to tell my niece about it who is in graduate school in psychology maybe she can do some research on it and help out some it sounds like someone needs to just pick up this ball and run with it too bad nobody has before now sounds like it could have helped a bunch of people.

  • Charles

    May 14th, 2013 at 1:43 AM

    Not to sure on something here-why does overscreening maybe lead to people taking antidepressants who don’t need it. it sounds like it ain’t a problem with the screening but what’s being done with the results. i think people still need to be screened but maybe the yahoos reading the screening need to figure out who needs medicine and who don’t. Stopping the screening would be throwing the baby out with the bath water. Just cause one parts broke don’t mean you have to throw the whole thing away. Just fix the broke part.

  • Ashton

    May 14th, 2013 at 1:45 AM

    There are certainly other remedies for depression than antidepressants. Maybe those alternatives need to be used.

  • Shandy

    May 14th, 2013 at 3:53 AM

    My thoughts are that it is never a bad idea for anyone to be screened for depression whether they have heart problems or not. This is not something that should be taken lightly although I think that in many sectors it still is. I know that not every heart patient is going to be depressed, just as not every depressed person will not have future cardiac problems. But there are times when the two go together and even when they don’t it still isn’t a bad idea to know who could be more at risk.

  • fire spice

    May 14th, 2013 at 11:26 PM

    well cardiac problems could render you incapable of several things including excessive exercise and certain sports.that could lead to depression if you were formerly involved in those activities.

    so it may lead to but not necessarily.a bio of the patient could make this decision a little easier – whether to screen for depression or not.

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