Abstract 10048: Depression Screening by Nurses in Hospitalized Acute Coronary Syndrome Patients
Background: Depression screening in cardiac patients is recommended by the AHA, but the best approach for in-hospital screening is unclear.
Objective: To evaluate the accuracy of common versions of the Patient Health Questionnaire (PHQ) when utilized by staff RNs for depression screening in hospitalized ACS patients.
Methods: We enrolled 100 ACS patients (63.5 ± 12.2 years, 31% female) on a cardiac step down unit. Staff RNs administered the PHQ-2, -9, and -10. To determine clinical depression, diagnostic interviews using the Diagnostic Interview and Structured Hamilton (DISH) were conducted by advanced practice nurses blinded to PHQ results. With the DISH as a criterion, receiver operating characteristics analyses were done for each of 3 PHQ versions. Pairwise comparisons were done by the Delong method. Cut-off scores balancing false negatives and false positives were identified by the Youden index (Sensitivity + Specificity - 100).
Results: Depressed patients (n=23) were more often single (74% vs 36%, p. = .001), non-white (65% vs 42%, p. = .046), younger (56.6 ± 13.4 vs 65.5 ± 11.2 years, p. = 002) and had greater BMI (32.1 ± 7.3 vs 29.4 = 4.5, p = .002) than non-depressed patients. At cut off scores based on high sensitivity and the Youden Index, each PHQ version demonstrated strong AUC statistics (Table). No statistical differences in AUCs were seen between the PHQs. Each yielded higher symptom scores in depressed vs non-depressed patients (PHQ-2; 3.4 ± 1.8 vs 0.6 ± 1.1, p .001, PHQ-9; 13 ± 5.3 vs 3.4 ± 3.9, p .000; PHQ-10: 14.5 ± 5.7 vs 3.6 ± 4.2, p = .000).
Conclusions: For screening of depression in hospitalized ACS patients, the PHQ-2 is as accurate as longer PHQ versions. Staff nurses are able to accurately administer the PHQ-2 in a busy hospital unit. Together, these characteristics support its use as recommended by AHA. Further study is needed to determine if PHQ-2 screening changes clinical decision-making or improves outcomes in hospitalized ACS patients.
- © 2011 by American Heart Association, Inc.