title: A positive 2-item Patient Health Questionnaire depression screen among hospitalized heart failure patients is associated with elevated 12-month mortality.
abstract: BACKGROUND
  Given the association of depression with poorer cardiac outcomes, an American Heart Association Science Advisory has advocated routine screening of cardiac patients for depression using the 2-item Patient Health Questionnaire (PHQ-2) "at a minimum." However, the prognostic value of the PHQ-2 among HF patients is unknown.
  
  
  RESULTS
  We screened hospitalized HF patients (ejection fraction [EF] <40%) that staff suspected may be depressed with the PHQ-2, and then determined vital status at up to 12-months follow-up. At baseline, PHQ-2 depression screen-positive patients (PHQ-2+; n = 371), compared with PHQ-2 screen-negative patients (PHQ-2-; n = 100), were younger (65 vs 70 years) and more likely to report New York Heart Association (NYHA) functional class III/IV than class II symptoms (67% vs. 39%) and lower levels of physical and mental health-related quality of life (all P ≤ .002); they were similar in other characteristics (65% male, 26% mean EF). At 12 months, 20% of PHQ-2+ versus 8% of PHQ-2- patients had died (P = .007) and PHQ-2 status remained associated with both all-cause (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.4-6.7; P = .003) and cardiovascular (HR 2.7, 95% CI 1.1-6.6; P = .03) mortality even after adjustment for age, gender, EF, NYHA functional class, and a variety of other covariates.
  
  
  CONCLUSIONS
  Among hospitalized HF patients, a positive PHQ-2 depression screen is associated with an elevated 12-month mortality risk.
authors.affiliation: Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. rollmanbl@upmc.edu
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
authors.forename: Bea
authors.initials: B
authors.lastname: Herbeck Belnap
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Fanyin
authors.initials: F
authors.lastname: He
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Alvarez
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult