Mental Health Intervention Urged for Heart Patients

Heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery and overall health, according to a scientific advisory issued Monday by the American Heart Association and co-authored by a Yale School of Public Health researcher.

“Depression and heart disease seem to be very much intertwined,” said Judith H. Lichtman, co-chair of the statement and associate professor of epidemiology at the Yale School of Public Health. “You can’t treat the heart in isolation from the patient’s mental health.”

The American Psychiatric Association has endorsed the statement—the first of its kind on the link between heart disease and depression. Some of its recommendations include:

  • Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician’s office and cardiac rehabilitation center.
  • Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.
  • Careful monitoring of patients to ensure adherence to their treatment plan.
  • Coordination between health care professionals treating patients with combined medical and mental health diagnoses.

While there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory does state that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life.

“By understanding the prevalence of depression and learning more about the subgroups of heart patients at particular risk of depression, we can begin to understand the best ways to recognize and treat it,” said Lichtman.

Depression is approximately three times more common in people with heart complications than in the general population and as many as 20 percent of heart patients meet the criteria for major depression. Studies suggest that younger women in particular may be at high risk.

The advisory recommends that heart patients initially be evaluated with a simple two-item assessment. If even one of the questions generates a “yes” response, it is recommended that a more in-depth screening be done with a total of nine questions. Heart patients found to be suffering from depression can benefit from a number of treatment options, including behavioral therapy, physical activity, cardiac rehabilitation, antidepressant drugs, or combinations of these treatments.

Co-authors include J. Thomas Bigger, Jr., M.D.; James A. Blumenthal, Ph.D., ABPP; Nancy Frasure-Smith, Ph.D.; Peter G. Kaufmann, Ph.D.; Francois Lesperance, M.D.; Daniel B. Mark, M.D., M.P.H.; David S. Sheps, M.D., M.P.H.; and C. Barr Taylor, M.D. Individual author disclosures are included on the manuscript.

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