Depression in Cardiac Patients: What can Nurses do about it?

Depression is increasingly being recognized as a significant problem in cardiac patients, both as a predictor and an outcome. A growing body of evidence suggests that depression following a cardiac event is a significant factor for both mortality and morbidity [1] and that depression is also a significant predictor of coronary heart disease in initially healthy people [2]. Depression is a multifaceted disorder, encompassing a wide range of somatic, cognitive and mood symptoms, and it varies in intensity, duration, frequency and course, thus often rendering comparisons of data impossible [3]. Thus, although the prevalence of depressive symptoms or major depression in cardiac patients varies across studies it is around three times that of the general population. Yet, in many instances depression escapes detection and, as a consequence, patients do not receive a proper assessment and appropriate treatment [4]. A range of screening and assessment techniques can be used. The clinical diagnostic interview is the ideal but is often impractical and so, in routine clinical practice, the choice is usually either a self-report measure or reliance on a clinical judgement or feeling. A variety of self-report measures are available, the commonest being the Beck Depression Inventory (BDI) [5] or Hospital Anxiety and Depression Scale (HADS) [6], though others, developed specifically for cardiac patients [7,8] are appealing, particular in terms of performing a brief and rapid assessment. The choice of the measure will depend on the target patient population and the psychometric properties of the instrument concerned [4].