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Poor uptake of depression care in cardiology

Published online by Cambridge University Press:  02 January 2018

Phillip J. Tully*
Affiliation:
University of Adelaide, Australia. Email: phillip.tully@adelaide.edu.au
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2017 

Depression is associated with poorer coronary heart disease (CHD) outcomes; however, routine screening for depression is controversial and difficult to implement in clinical practice, and randomised clinical trial (RCT) evidence is scarce. Reference Thombs, Roseman, Coyne, de Jonge, Delisle and Arthurs1 The DEPSCREEN-INFO parallel group efficacy RCT reported by Löwe et al Reference Löwe, Blankenberg, Wegscheider, König, Walter and Murray2 randomised participants to written patient-targeted feedback versus no written patient feedback after depression screening. The sample comprised in-patients and out-patients with CHD, but also those with arterial hypertension. Löwe et al argued that the role of the patient within the depression screening process had not yet been studied. Previously, we reported two examples of depression screening involving patient, general practitioner and cardiologist feedback in heart failure Reference Tully, Wittert, Selkow and Baumeister3 and cardiac surgery populations. Reference Tully, Baumeister, Bennets, Rice and Baker4 Our findings, and those of others, Reference Coventry, Lovell, Dickens, Bower, Chew-Graham and McElvenny5,Reference Rollman, Belnap, LeMenager, Mazumdar, Houck and Counihan6 diverge from Löwe et al's in terms of mental health service use.

Lowe et al showed that 13% of participants contacted a psychotherapist, which might reflect generous health insurance benefits in Germany, including up to 2 years of psychotherapy. By comparison, in England an RCT for depression and CHD or diabetes by Coventry et al Reference Coventry, Lovell, Dickens, Bower, Chew-Graham and McElvenny5 revealed that 33% of individuals randomised to collaborative care did not attend any depression treatment session. Coventry et al Reference Coventry, Lovell, Dickens, Bower, Chew-Graham and McElvenny5 used the Improving Access to Psychological Therapy (IAPT) services in the English National Health Service (NHS). Other depression screening studies in CHD indicate that uptake of mental health services is <2% in the USA Reference Rollman, Belnap, LeMenager, Mazumdar, Houck and Counihan6 and Australia, Reference Tully, Baumeister, Bennets, Rice and Baker4 with the latter study providing a rebate for mental health services similar to IAPT. Mounting evidence indicates incongruity between international efforts to improve depression care and the uptake of mental health services by the CHD patients we are targeting with depression screening. Integration of mental health services within cardiology and primary care services may be warranted. Clearly, more concerted efforts are required internationally to improve existing mental health services by adopting innovative methods such as ‘blended’ collaborative care, computerised cognitive–behavioural therapy (CBT) and telehealth. It remains crucial to better align mental health services with CHD patient needs in order to better engage CHD patients.

References

1 Thombs, BD, Roseman, M, Coyne, JC, de Jonge, P, Delisle, VC, Arthurs, E, et al. Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review. PLoS ONE 2013; 8: e52654.Google Scholar
2 Löwe, B, Blankenberg, S, Wegscheider, K, König, H-H, Walter, D, Murray, AM, et al. Depression screening with patient-targeted feedback in cardiology: DEPSCREEN-INFO randomised clinical trial. Br J Psychiatry 2017; 210: 132–9.CrossRefGoogle ScholarPubMed
3 Tully, PJ, Wittert, GA, Selkow, T, Baumeister, H. The real world mental health needs of heart failure patients are not reflected by the depression randomized controlled trial evidence. PLoS ONE 2014; 9: e85928.CrossRefGoogle Scholar
4 Tully, PJ, Baumeister, H, Bennets, JS, Rice, GD, Baker, RA. Depression screening after cardiac surgery: a six month longitudinal follow up for cardiac events, hospital readmissions, quality of life and mental health. Int J Cardiol 2016; 206: 4450.Google Scholar
5 Coventry, P, Lovell, K, Dickens, C, Bower, P, Chew-Graham, C, McElvenny, D, et al. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ 2015; 350: h638.CrossRefGoogle ScholarPubMed
6 Rollman, BL, Belnap, BH, LeMenager, MS, Mazumdar, S, Houck, PR, Counihan, PJ, et al. Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA 2009; 302: 2095–103.CrossRefGoogle ScholarPubMed
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