Bridging Cardiac and Mental Health: Screening for Depression in Cardiology Settings

TL;DR

Depression is common in heart disease patients and can worsen outcomes, but screening is not consistently used in cardiology settings.

Contribution

This review identifies effective screening tools and barriers to implementing depression screening in cardiology clinics.

Findings

Depression prevalence in cardiovascular patients ranges from 15% to 30%.

A two-step screening approach using PHQ-2 and PHQ-9 is effective and minimizes patient burden.

Barriers include time constraints, workflow issues, and patient stigma.

Abstract

Depression is a highly prevalent comorbidity in patients with cardiovascular disease (CVD), affecting approximately one in five cardiac patients and contributing to adverse cardiovascular outcomes, increased mortality, and reduced quality of life. Despite clinical guidelines from the American Heart Association recommending routine depression screening, implementation remains inconsistent across cardiology settings. This narrative review synthesizes current evidence on depression screening practices in cardiology clinics, examining prevalence, screening tools, and implementation barriers. The prevalence of depression in cardiovascular patients ranges from 15% to 30%, with higher rates observed in post-myocardial infarction and heart failure populations globally. The two-step screening approach using Patient Health Questionnaire-2 (PHQ-2) followed by Patient Health Questionnaire-9 (PHQ-9) demonstrates optimal sensitivity (83-87%) and specificity (78-92%) while minimizing patient burden. Major implementation barriers include time constraints, inadequate workflow integration, insufficient mental health resources, provider knowledge gaps, and patient-level factors, including stigma and poor treatment acceptance. Successful implementation of depression screening in cardiology clinics requires multilevel strategies addressing system, provider, and patient factors through electronic health record integration, standardized protocols, collaborative care models, and stakeholder engagement.

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