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Diagnosis and treatment of depression following routine screening in patients with coronary heart disease or diabetes: a database cohort study

Published online by Cambridge University Press:  18 July 2012

C. Burton ,
C. Simpson  and
N. Anderson
C. Burton*
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, UK
C. Simpson
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, UK
N. Anderson
Affiliation:
Centre for Population Health Sciences, University of Edinburgh, UK
*
*Address for correspondence: Dr C. Burton, Centre for Population Health Sciences, University of Edinburgh, Doorway 1 Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK. (Email: [email protected])
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Abstract

Background

Depression is common in chronic illness and screening for depression has been widely recommended. There have been no large studies of screening for depression in routine care for patients with chronic illness.

Method

We performed a retrospective cohort study to examine the timing of new depression diagnosis or treatment in relation to annual screening for depression in patients with coronary heart disease (CHD) or diabetes. We examined a database derived from 1.3 million patients registered with general practices in Scotland for the year commencing 1 April 2007. Eligible patients had either CHD or diabetes, were screened for depression during the year and either received a new diagnosis of depression or commenced a new course of antidepressant (excluding those commonly used to treat diabetic neuropathy). Analysis was by the self-controlled case-series method with the outcome measure being the relative incidence (RI) in the period 1–28 days after screening compared to other times.

Results

A total of 67358 patients were screened for depression and 2269 received a new diagnosis or commenced treatment. For the period after screening, the RI was 3.03 [95% confidence interval (CI) 2.44–3.78] for diagnosis and 1.78 (95% CI 1.54–2.05) for treatment. The number needed to screen was 976 (95% CI 886–1104) for a new diagnosis and 687 (95% CI 586–853) for new antidepressant treatment.

Conclusions

Systematic screening for depression in patients with chronic disease in primary care results in a significant but small increase in new diagnosis and treatment in the following 4 weeks.

Keywords

Antidepressant treatmentcoronary heart diseasediabetesdepressionscreening
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 3 , March 2013 , pp. 529 - 537
Copyright
Copyright © Cambridge University Press 2012

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References

Ali, S, Stone, MA, Peters, JL, Davies, MJ, Khunti, K (2006). The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabetic Medicine 23, 1165–1173.CrossRefGoogle ScholarPubMed
Arroll, B, Goodyear-Smith, F, Crengle, S, Gunn, J, Kerse, N, Fishman, T, Falloon, K, Hatcher, S (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine 8, 348–353.CrossRefGoogle ScholarPubMed
Burton, C, Anderson, N, Wilde, K, Simpson, CR (2012). Factors associated with duration of new antidepressant treatment: analysis of a large primary care database. British Journal of General Practice 62, e104–e112.CrossRefGoogle ScholarPubMed
Coventry, PA, Hays, R, Dickens, C, Bundy, C, Garrett, C, Cherrington, A, Chew-Graham, C (2011). Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care. BMC Family Practice 12, 10.CrossRefGoogle ScholarPubMed
Davidson, KW, Rieckmann, N, Clemow, L, Schwartz, JE, Shimbo, D, Medina, V, Albanese, G, Kronish, I, Hegel, M, Burg, MM (2010). Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. Archives of Internal Medicine 170, 600–608.CrossRefGoogle ScholarPubMed
Doran, T, Fullwood, C, Gravelle, H, Reeves, D, Kontopantelis, E, Hiroeh, U, Roland, M (2006). Pay-for-performance programs in family practices in the United Kingdom. New England Journal of Medicine 355, 375–384.CrossRefGoogle ScholarPubMed
Elder, R, Kirkpatrick, M, Ramsay, W, MacLeod, M, Guthrie, B, Sutton, M (2007). Measuring Quality in Primary Medical Services using Data from SPICE. Information and Statistics Division, NHS National Services Scotland: Edinburgh.Google Scholar
Gilbody, S, House, AO, Sheldon, TA (2005). Screening and case finding instruments for depression. Cochrane Database of Systematic Reviews (Online) 4, CD002792.Google Scholar
IDF (2005). Psychological care. In Global Guideline for Type 2 Diabetes, pp. 19–21. International Diabetes Federation: Brussels.Google Scholar
ISD Scotland (2011). General practice – quality & outcomes framework, 2007/08 achievement summaries at practice level (http://www.isdscotlandarchive.scot.nhs.uk/isd/6434.html). Accessed 27 June 2012.Google Scholar
Karasz, A, Dowrick, C, Byng, R, Buszewicz, M, Ferri, L, Hartman, TCO, van Dulmen, S, Weel-Baumgarten, E, Reeve, J (2012). What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes. British Journal of General Practice 62, e55–e63.CrossRefGoogle ScholarPubMed
Katon, WJ, Von Korff, M, Lin, EH, Simon, G, Ludman, E, Russo, J, Ciechanowski, P, Walker, E, Bush, T (2004). The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry 61, 1042–1049.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Lichtman, JH, Bigger, Jr. JT, Blumenthal, JA, Frasure-Smith, N, Kaufmann, PG, Lesperance, F, Mark, DB, Sheps, DS, Taylor, CB, Froelicher, ES (2008). Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 118, 1768–1775.CrossRefGoogle ScholarPubMed
Moore, M, Yuen, HM, Dunn, N, Mullee, MA, Maskell, J, Kendrick, T (2009). Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. British Medical Journal 339, b3999.CrossRefGoogle ScholarPubMed
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851–858.CrossRefGoogle ScholarPubMed
NICE (2009 a). Depression in adults (update). National Institute for Health and Clinical Excellence (NICE). Guideline 90.Google Scholar
NICE (2009 b). Depression in adults with a chronic physical health problem – treatment and management. National Institute for Health and Clinical Excellence (NICE). Guideline 91.Google Scholar
O'Connor, EA, Whitlock, EP, Beil, TL, Gaynes, BN (2009). Screening for depression in adult patients in primary care settings: a systematic evidence review. Annals of Internal Medicine 151, 793–803.CrossRefGoogle ScholarPubMed
Pouwer, F (2009). Should we screen for emotional distress in type 2 diabetes mellitus? Nature Reviews Endocrinology 5, 665–671.CrossRefGoogle ScholarPubMed
Pouwer, F, Beekman, AT, Lubach, C, Snoek, FJ (2006). Nurses' recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Education and Counseling 60, 235–240.CrossRefGoogle ScholarPubMed
Pouwer, F, Tack, CJ, Geelhoed-Duijvestijn, PH, Bazelmans, E, Beekman, AT, Heine, RJ, Snoek, FJ (2011). Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial. Diabetologia 54, 741–748.CrossRefGoogle ScholarPubMed
R Development Core Team (2011). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.Google Scholar
Thombs, BD, de Jonge, P, Coyne, JC, Whooley, MA, Frasure-Smith, N, Mitchell, AJ, Zuidersma, M, Eze-Nliam, C, Lima, BB, Smith, CG, Soderlund, K, Ziegelstein, RC (2008 a). Depression screening and patient outcomes in cardiovascular care: a systematic review. Journal of the American Medical Association 300, 2161–2171.CrossRefGoogle ScholarPubMed
Thombs, BD, Ziegelstein, RC, Whooley, MA (2008 b). Optimizing detection of major depression among patients with coronary artery disease using the Patient Health Questionnaire: data from the Heart and Soul Study. Journal of General Internal Medicine 23, 2014–2017.CrossRefGoogle ScholarPubMed
Whitaker, HJ, Farrington, CP, Spiessens, B, Musonda, P (2006). Tutorial in biostatistics: the self-controlled case series method. Statistics in Medicine 25, 1768–1797.CrossRefGoogle ScholarPubMed
Whooley, MA, Avins, AL, Miranda, J, Browner, WS (1997). Case-finding instruments for depression. Two questions are as good as many. Journal of General Internal Medicine 12, 439–445.CrossRefGoogle ScholarPubMed
Whooley, MA, de Jonge, P, Vittinghoff, E, Otte, C, Moos, R, Carney, RM, Ali, S, Dowray, S, Na, B, Feldman, MD, Schiller, NB, Browner, WS (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. Journal of the American Medical Association 300, 2379–2388.CrossRefGoogle ScholarPubMed
Ziegelstein, RC, Thombs, BD, Coyne, JC, de Jonge, P (2009). Routine screening for depression in patients with coronary heart disease never mind. Journal of the American College of Cardiology 54, 886–890.CrossRefGoogle ScholarPubMed
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