title: Feasibility and utility of screening for depression and anxiety disorders in patients with cardiovascular disease.
abstract: BACKGROUND
  Depression and anxiety in patients with cardiac disease are common and independently associated with morbidity and mortality. We aimed to explore the use of a 3-step approach to identify inpatients with cardiac disease with depression, generalized anxiety disorder (GAD), or panic disorder; understand the predictive value of individual screening items in identifying these disorders; and assess the relative prevalence of these disorders in this cohort.
  
  
  RESULTS
  To identify depression and anxiety disorders in inpatients with cardiac disease as part of a care management trial, an iterative 3-step screening procedure was used. This included an existing 4-item (Coping Screen) tool in nursing data sets, a 5-item screen for positive Coping Screen patients (Patient Health Questionnaire-2 [PHQ-2], GAD-2, and an item about panic attacks), and a diagnostic evaluation using PHQ-9 and the Primary Care Evaluation of Mental Disorders anxiety disorder modules. Overall, 6210 inpatients received the Coping Screen, 581 completed portions of all 3 evaluation steps, and 210 received a diagnosis (143 depression, 129 GAD, 30 panic disorder). Controlling for age, sex, and the other screening items, PHQ-2 items independently predicted depression (little interest/pleasure: odds ratio [OR]=6.65, P<0.001; depression: OR=5.24, P=0.001), GAD-2 items predicted GAD (anxious: OR=4.09, P=0.003; unable to control worrying: OR=10.46, P<0.001), and the panic item predicted panic disorder (OR=49.61, P<0.001).
  
  
  CONCLUSIONS
  GAD was nearly as prevalent as depression in this cohort, and GAD-2 was an effective screening tool; however, panic disorder was rare. These results support the use of 2-step screening for depression and GAD beginning with a 4-item scale (GAD-2 plus PHQ-2).
  
  
  BACKGROUND
  Unique Identifier: NCT01201967. URL: http://www.clinicaltrials.gov/ct2/show/NCT01201967.
authors.affiliation: Harvard Medical School, Boston, MA, USA. ccelano@partners.org
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Celano
authors.forename: Laura
authors.initials: L
authors.lastname: Suarez
authors.forename: Carol
authors.initials: C
authors.lastname: Mastromauro
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D001900:Boston / Q000453:epidemiology; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011237:Predictive Value of Tests; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016037:Single-Blind Method; D011795:Surveys and Questionnaires
keywords: anxiety; cardiovascular disease; depression; screening