Effect of psychiatry liaison with general practitioners on depression severity in recently hospitalised cardiac patients: a randomised controlled trial.
OBJECTIVE
To evaluate the effect on depressive symptoms in cardiac patients of patient-specific advice to general practitioners regarding management of comorbid depression.


METHODS
A randomised controlled trial in four general hospitals in Adelaide, South Australia.


METHODS
Patients (n = 669) admitted to cardiology units for a range of cardiovascular conditions who were screened and assessed as being depressed according to the Center for Epidemiological Studies Depression Scale (CES-D).


METHODS
Inpatient psychiatric review, followed by telephone case conferencing between specialist hospital staff and GPs to provide patient-specific information about the patient's depression and its management, educational material, and ongoing clinical support.


METHODS
Level of depression severity at 12 months post-hospitalisation.


RESULTS
On the basis of intention to treat, intervention patients had lower rates of moderate to severe depression (CES-D > or = 27) after 12 months (25% v 35%, relative risk, 0.72; 95% CI, 0.54-0.96, number needed to treat for benefit, 11). The intervention was most effective in preventing progression from mild depression to moderate to severe depression. The multidisciplinary telephone case conferencing was difficult to implement and, in a post hoc analysis, brief phone advice from a psychiatrist was found to be effective.


CONCLUSIONS
Screening hospitalised cardiac patients for depression and providing targeted advice to their GPs reduces depression severity 12 months after hospitalisation.
Schrader
Geoff
G
Department of Psychiatry, University of Adelaide, Queen Elizabeth Hospital, Woodville, SA 5011, Australia. geoffrey.schrader@adelaide.edu.au
Cheok
Frida
F
Hordacre
Ann-Louise
AL
Marker
Julie
J
Wade
Victoria
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000145:classification / Q000209:etiology* / Q000628:therapy*; D005194:Family Practice / Q000379:methods*; D005260:Female; D006304:Health Status; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D011570:Psychiatry / Q000379:methods*; D016896:Treatment Outcome