For cardiac patients the risk of myocardial infarction goes up substantially when someone also has a history of depression for reasons we don't fully understand. It also impacts their utilization of healthcare services. Having depression is associated with a two-fold increased risk of being readmitted to the hospital.
Essentially virtually every feature of healthcare is impacted in a negative way by depression. You can only address it and help somebody with depression if you first recognize it. The purpose of this initiative is to screen patients so that we can identify them more readily and give the patients information they need to empower them to be able to get help if they choose to.
HLM: What does the screening process involve?
ID: It is quite straightforward. There are a number of screening tools for depression. The ones we are using are called the Patient Health Questionnaire. There are two forms of it: the PHQ-2 and the PHQ-9 that screen for depression. They ask about the symptoms of depression and the purpose of the PHQ 2 is a broad screener. Are they depressed? Have they lost interest in things? That's used by the nurse to then ask the rest of the questions if the patient is positive.
If not, they move on with the rest of their assessment. It is easy to do and it is a measure that has been tested and validated in many different healthcare environments. It can be appropriately administered by many different health professionals.
The challenge of detecting depression in the medical setting is that there are many medical conditions that can cause symptoms or syndromes that can look like depression. So it is important to have a physician or an allied health professional evaluating the patient to disentangle various forms of depression and give the patient guidance on how to find treatment for it.