Depression screening: few changes in mental health outcomes after ACS

  • Kronish IM & al.
  • JAMA Intern Med
  • 21 Oct 2019

  • International Clinical Digest
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Takeaway

  • Systematic depression screening in patients after acute coronary syndrome (ACS) is not tied to changes in quality-adjusted life years (QALYs), depression-free days, or death, bleeding, or sleep problems.
  • No change was seen whether the patients had depression treatment or not in this randomized trial.

Why this matters

  • Patients who have elevated depression symptoms after ACS have increased risks for several negative outcomes, suggesting that systematic screening might offer benefit.

Key results

  • 7.1% of screened survivors had elevated scores on the depression screen.
  • Vs patients with ACS not screening positive, QALYs did not differ with screening compared with no screening, regardless of follow-up with positive screen (standard deviation [SD]):
    • Screen, notify, treat, −0.06 (0.20);
    • Screen and notify, −0.06 (0.20); and
    • No screen, −0.06 (0.18; P=.98).
  • Other outcomes were similarly unaffected.

Study design

  • Randomized trial at 4 sites, with 1500 patients (women, 424; men, 1076; mean [SD] age, 65.9 [11.5] years) after ACS with no history of depression.
  • Patients were randomly allocated to screen/notify/treat, screen/notify, or no screen (usual care) groups.
  • Screening tool was 8-item Patient Health Questionnaire.
  • Funding: National Heart, Lung, and Blood Institute.

Limitations

  • Patients in the no-screening group might have become more alert to their own depressive symptoms.
  • Treatment was heterogeneous.