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. DESIGN AND SETTING: A randomised controlled trial in four general hospitals in Adelaide, South Australia. PARTICIPANTS: 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). INTERVENTION: 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. MAIN OUTCOME MEASURES: 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.