P-522: Screening for depression and anxiety in a hypertension specialty clinic

• Published in: American journal of hypertension 2004-05, Vol.17 (S1), p.224A-224A
• Main Authors: Barud, Stephanie J., King, Deborah S., Reed, Rebecca R., Harkins, Kimberly G., Wofford, Marion R., Noble, Sara L.
• Format: Article
• Language: English
• Subjects: Anxiety; Depression; Risk Factors
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2004.03.596

The relationship of depression to coronary heart disease, hypertension and stroke continues to evolve. Recent epidemiologic data have shown depression to be an independent risk factor for cardiovascular morbidity and mortality both in patients with and without cardiac disease. Additional studies link psychosocial factors to the pathogenesis of cardiovascular disease (CVD). The pathophysiological association between depression/anxiety and CVD possibly involves multiple pathways including behavioral factors, abnormalities in platelet reactivity, noradrenergic and HPA hyperactivity, and cardiac instability. Due to the subjective nature of symptom reporting, depression/anxiety frequently go unrecognized and therefore untreated. Patients with untreated depression/anxiety also often exhibit labile blood pressures, white coat hypertension, or significant white coat effect which respond to treatment of the underlying disorder. Because of the frequent co-occurrence of these very common and disabling diseases, screening for depression/anxiety should become routine in patients with CVD. The purposes of this study are to determine the usefulness of a validated survey instrument, the Brief Patient Health Questionnaire (PHQ), in assessing symptoms of depression/anxiety within this clinic population and categorize the co-occurrence of these symptoms in those followed for either primary or secondary cardiovascular prevention. All patients are asked to complete the PHQ. After survey completion, depression/anxiety symptoms and appropriateness of treatment are documented. A retrospective chart review is also completed to determine prior symptom documentation or treatment and cardiovascular prevention status. The temporal relationship of symptom appearance and cardiovascular events is also assessed in those patients with an event history. Survey implementation began August, 2003. Of patients surveyed to date, 83% are followed for primary prevention and 17% for secondary prevention. Preliminary results document depression or anxiety symptoms in 27% of those surveyed. Of these, 48% had symptoms of depression, 37% symptoms of panic syndrome, 19% symptoms of major depression, and 19% had symptoms of both major depressive and panic syndrome. The questionnaire has been useful and patient acceptance satisfactory. Implementation has provided another method of identifying risk factors and increasing communication between providers and patients. Am J Hypertens (2004) 17, 224A–224A; doi