title: The prognostic impact and optimal timing of the Patient Health Questionnaire depression screen on 4-year mortality among hospitalized patients with systolic heart failure.
abstract: An American Heart Association (AHA) Science Advisory recommends patients with coronary heart disease undergo routine screening for depressive symptoms with the two-stage Patient Health Questionnaire (PHQ). However, little is known on the prognostic impact of a positive PHQ screen on heart failure (HF) mortality.
  
  
  
  We screened hospitalized patients with systolic HF (left ventricle ejection fraction≤40%) for depression with the two-item Patient Health Questionnaire (PHQ-2) and administered the follow-up nine-item Patient Health Questionnaire (PHQ-9) both immediately following the PHQ-2 and by telephone 1 month after discharge. Later, we ascertained vital status at 4-year follow-up on all patients who completed the inpatient PHQ-9 and calculated mortality incidence and risk by baseline PHQ.
  
  
  
  Of the 520 HF patients we enrolled, 371 screened positive for depressive symptoms on the PHQ-2. Of these, 63% scored PHQ-9≥10 versus 24% of those who completed the PHQ-9 1 month later (P<.001). PHQ-2 positive status was an independent predictor of 4-year all-cause mortality (HR: 1.50; P=.04), and mortality incidence was similar by baseline PHQ-9 score.
  
  
  
  Among hospitalized patients with systolic HF, a positive PHQ-2 screen for depressive symptoms is an independent risk factor for increased 4-year all-cause mortality. Our findings extend the AHA's Science Advisory for depression to hospitalized patients with systolic HF.
authors.affiliation: Kellogg Eye Institute, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Tatiana K
authors.initials: TK
authors.lastname: Deveney
authors.affiliation: Division of General Internal Medicine, Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany.
authors.forename: Bea Herbeck
authors.initials: BH
authors.lastname: Belnap
authors.affiliation: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.affiliation: Division of General Internal Medicine, Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: rollmanbl@upmc.edu.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Rollman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000401:mortality* / Q000523:psychology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000073222:Patient Health Questionnaire / Q000592:standards*; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult
keywords: Depression; Patient Health Questionnaire; heart failure; mortality; screening