Heart Patients Should Be Screened for Depression
> 10/2/2008 6:53:00 PM

The link between heart disease and depression grows more apparent with ongoing research. In its most recent press release, the American Heart Association recommends ongoing depression screenings for every heart patient. 

Feelings of confusion and despondency are common after major surgeries or events like stroke and heart attack. Physical exhaustion and an inability to maintain a previously active lifestyle also contribute to a heightened awareness of one’s own physical handicaps. Recovery rates are understandably lower among cancer patients suffering from depression and anxiety, which can contribute to pre-existing problems with high blood pressure, irregular heart rhythms and a weakened immune system. Previous studies have examined the very real ability of depression to handicap the body’s reparative abilities. It can increase the likelihood of cardiovascular emergencies like recurring heart attacks and blood clots. And it is up to three times more common among heart patients than the general population, but treatment rates do not reflect this statistical jump. Less than 50% of heart doctors told an AHA pollster that they address possible depression among their patients and many who are positively diagnosed still go without treatment. 

Research has yet to link post-treatment depression screening with improved outcomes. But the connection between depression and a diminished quality of life is well established. Affected patients are less likely to pay close attention to their post-treatment status by taking their medications as directed, getting light exercise each day, attending rehabilitation sessions and maintaining regular social activities. Post-trauma survival statistics reflect the fact that destructive behaviors associated with severe depression (smoking, drinking, social isolation, fatigue) can be especially harmful to heart patients. One particularly disturbing study saw six-month mortality rates for heart attack victims increased from 3% to 17% among depressed individuals. 

Screening each patient is not a solution in itself. But any health professional can administer the simple 9-item questionnaires. Mental health experts are not necessary at the beginning of a process that can begin, according to the AHA panel, with two simple questions: have you noticed a loss of normal pleasures since your surgery and would you describe your subsequent emotional state as “down, depressed, or hopeless?” An unfortunate number of recovering patients would answer yes to one or both. Some professionals go further with their recommendations. At least one of the doctors interviewed for this story insists that close monitoring is necessary for each patient because so many will not follow up even if they receive a positive diagnosis.

One can easily downplay the importance of mental health concerns in the wake of a life-threatening physical trauma like heart disease. To do so would be a grave mistake. Depression affects every aspect of daily life and must be of particular concern to those who’ve recently experienced major cardiovascular events. Loved ones and healthcare professionals should do more than just take note of depressive symptoms in heart patients. They should identify them before their influence becomes too great. And pre-emptive screening is the most effective option.

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