Two-step screening appears effective for anxiety, depression in hospitalized cardiac patients

A two-step screening process appears to be effective for detecting generalized anxiety disorder (GAD) and depression in hospitalized patients with cardiac disease, according to a new study.

In a care management trial, researchers screened hospitalized cardiac disease patients using a four-item tool in nursing data sets (Coping Screen), a five-item screening tool for patients who tested positive on the Coping Screen (Patient Health Questionnaire-2 [PHQ-2], GAD-2, plus an item on panic attacks), and diagnostic evaluation with PHQ-9 and the anxiety disorder modules from the Primary Care Evaluation of Mental Disorders.

The aim of the study was to see how well this three-step approach identified cardiac inpatients with depression, GAD, or panic disorder, as well as to assess prevalence and to ascertain the predictive value of individual screening items. Results were published early online June 11 by Circulation: Cardiovascular Quality and Outcomes.

A total of 6,210 patients completed the Coping Screen, and 581 completed all three of the screening components. Of the 6,210 patients, 63.7% were men and the average age was 66.5 years. Two hundred ten patients (30% of those who had the five-item screen and 36% of those who had disorder-specific screening) were diagnosed, 143 with depression, 129 with GAD, and 30 with panic disorder.

Researchers controlled for age, sex and other screening items and found that the PHQ-2 items independently predicted clinical depression (odds ratios [OR], 6.65 for little interest/pleasure [P<0.001] and 5.24 for depressed mood [P=0.001]). In addition, the panic item (having experienced an anxiety attack) predicted panic disorder (OR, 49.61 [P<0.001]) and GAD-2 items predicted GAD (ORs, 4.09 for anxiety [P=0.003] and 10.46 for unable to control worrying [P<0.001]).

The authors noted that they could not determine true prevalence rates of any of the disorders they screened for and that their results may not be generalizable, among other limitations. They called the performance of the three-step screening process “suboptimal,” in part because many patients were discharged before all three steps were completed, but said that the GAD-2 was “an effective screening tool.”

Based on their results, which suggested that GAD and depression were equally prevalent in this population but panic disorder occurred relatively rarely, they recommended using the similarly scored PHQ-2 plus GAD-2 to screen inpatients with cardiac disease for anxiety and depression. “When scoring the frequency of each item on a scale of 0 to 3 (0=not at all, 1=several days, 2=more than half the days, 3=nearly every day), a total score of ≥6 should signal clinicians to investigate the symptoms further,” the authors wrote.