Abstract 2669: Screening for Mental Health Symptoms: Winning the Hearts and Minds of Patients in a Cardiology Clinic
Objective: Symptoms of depression and distress are associated with poor outcomes in patients with cardiovascular illnesses. Unfortunately, they are frequently underrecognized. Although screening has been recommended, in fact there is little information about “real-world” implementation of mental health screening programs in cardiology clinics. Of particular interest are rates of detection, likelihood of psychiatric follow-up, and suicidality detection in such programs.
Methods: Data have been analyzed for 316 patients who were screened between June 2005 and April 2006 in an urban, culturally diverse cardiology clinic at Elmhurst Medical Center in Queens, New York. We used the Patient Health Questionnaire (PHQ) and the Impact of Event Scale - both validated measures - to screen for depression and distress. Cardiologists discussed screening results with the patients, and decided whether to refer to further psychiatric care. In phase I of the program (N=132), identified patients were referred to an adjacent psychiatry clinic. In the second phase (N=184), a psychiatrist was placed in the cardiology clinic once a week.
Results: Nine percent of screened patients were referred to further psychiatric care. Forty-five patients (14%) endorsed some suicidal thoughts. Two of these patients (4%) were actively suicidal, and were hospitalized in a psychiatric unit after the evaluation. None of the patients who were referred to the adjacent psychiatry clinic in phase I came to the psychiatric appointment. In contrast, 13 of 17 patients (76%) who were referred in phase II (psychiatrist in the cardiology clinic) came to the follow-up (Chi Square, p<0.01).
Conclusion: Screening for depression and distress has resulted in the identification of a substantial (9%) minority of patients who needed mental health referral, and to detection of active suicidality in two patients. Placing the psychiatrist on the premises of the cardiology clinic significantly improved the rate of successful referral. Clinical mental health screening programs should include an immediate evaluation by a clinician, and preferably place a mental health professional within the cardiology clinic to improve the likelihood of follow-up.