Depression Screening by Nurses in Hospitalized Acute Coronary Syndrome Patients.

다국어 초록 (Multilingual Abstract)

Acute Coronary syndrome (ACS) coupled with depression is a deadly combination and has been the subject of a large body of research literature over the past decade. A scientific advisory was published by the American Heart Association in 2008 calling for the screening, referral, and treatment of depression in cardiac patients. At issue is the best way to do the screening of cardiac patients so that referral for further follow and treatment can be done. This dissertation explores the phenomenon of depression in ACS patients with an emphasis on screening by bedside registered nurses (RNs) and explores the symptoms of depression in ACS patients. Three manuscripts were written for the dissertation and are included as Chapters 2, 3, and 4.
Manuscript One: "Depression Screening in Hospitalized Post-ACS Patients: What can Nurses do?" The first paper is an in depth literature review of depression screening in ACS patients. Main points from the review include: Cardiac patients who suffer comorbid depression are known to have poorer health outcomes than similar cardiac patients without depression. Screening of cardiac patients prior to hospital discharge holds promise to improve detection of depressive symptoms and clinical depression. Detection of depression in cardiac patients followed by appropriate referral for follow up may lead to improved depression diagnosis and/or treatment, which in turn is likely lead to improved secondary prevention and HRQOL outcomes. Nurses are encouraged to stimulate meaningful research and facilitate change in collaboration with mental health professionals, primary care providers, and cardiologists in order to increase the recognition and potential treatment of depressed cardiac patients.
Manuscript Two: "Depression Screening: Utility of the PHQ-2 when used by RNs in Patients Hospitalized for ACS." In this study 100 patient were enrolled after being admitted to a cardiac unit for an ACS. They were screened by bedside nurses after a structure interview for the diagnosis of depression was done by an advanced practice nurse. Receiver operator characteristic curve analysis was done to assess the ability of RNs to utilize this brief tool that may be used to screen depression in the ACS population. This study demonstrated that the PHQ-2 administered by bedside RNs is a sensitive and specific means to screen hospitalized ACS patients with excellent operating characteristics. This together with previous research that reported the PHQ-2 as feasible and non resource intensive, suggest that it could be used for depression case finding in the hospitalized ACS patient.
Manuscript Three: "Depression Symptom Clusters in Hospitalized Cardiac Patients." A hierarchical cluster analysis was done on a sample of 323 cardiac patients with depression. Three distinct clusters were identified and included; cognitive/affective, somatic/affective, and somatic. Logistic regression analysis revealed depression is 1.4 times more likely in patients with cognitive/affective symptoms. Particular attention should be paid to the cognitive/affective cluster of symptoms identified: anhedonia, dysphoria, guilt, suicidal symptoms and nervous irritability. Heightened awareness of this cluster of symptoms may improve case finding for depression in hospitalized CHD patients so further assessment, referral, and treatment can be considered.