Abstract 5634: Outcomes of Early Referral for Depression in Low-Income, Minority Patients with Chronic Heart Failure
Background: Low-income, minority patients with chronic heart failure (CHF) are highly susceptible to depression and depressive symptoms, but they are less likely to receive treatment than others. The usefulness of established treatments such as early referral for counseling and/or anti-depressant therapy is unknown in disadvantaged groups. The purpose of this pilot study is to examine the effects of early referral and treatment on depressive symptoms in low-income, uninsured minorities with CHF.
Methods: A total sample of 94 patients (51% Hispanic, 74% male, aged 52.8 ± 11.4, ejection fraction 24 ± 9%, 68% non-ischemic cardiomyopathy, 88% NYHA class II–III, 72% unemployed) were enrolled from a CHF Disease Management Program at a public facility. Each patient underwent an initial evaluation, including clinical history, NYHA functional class, and screening for depressive symptoms by the Patient Health Questionnaire (PHQ)-2. Patients with positive PHQ-2 scores (≥1) were asked to complete the PHQ-9, to measure depression severity. Those with PHQ-9 scores ≥15 (moderate to severe symptoms) were referred to a social worker (SW) for further evaluation. Anti-depressants and/or counseling were offered after initial SW consultation. Depressive symptom severity was compared at baseline and one-year post-referral. Chi-square, t-tests, and multivariate analyses were used with significance set at p≪med>0.05.
Results: Over half (50 [53%]) of the total sample screened positive for depression. Compared with non-Hispanics, Hispanics tended to have a higher incidence of depression (30 [62%] vs. 20 [38%], p=0.06). Overall, 19 patients (31%) had moderate to severe depressive symptoms at baseline and received SW referral. While 3 (16%) declined any treatment, 16 (84%) received SW counseling; 7 (37%) received both counseling and anti-depressants. PHQ-9 scores decreased after treatment (17.7 ± 2.9 vs. 10.8 ± 4.2, p=0.001).
Conclusion: Depressive symptoms are very high in low-income, uninsured CHF patients, particularly in Hispanics. Early referral to treatment, including both counseling and anti-depressants, is effective in reducing depressive symptoms. Further research focusing on ethnic variations in the diagnosis and treatment of depression is needed.