Routine depression screenings fail to improve outcomes among heart attack survivors, based on results of a national trial testing the effects of depression screening and treatment. Findings were published in JAMA: Internal Medicine and cast doubt on the benefits of routine depression screenings in heart patients.
Depression is common after a heart attack and can double risk for future heart events and death, according to recent findings. For this reason, several medical societies recommend screening and treatment for depression in heart attack survivors. However, few studies have tested the effects of these mental health screenings, and experts wonder if there’s enough evidence to justify the new guidelines.
To learn more, researchers conducted a randomized clinical trial—considered the gold standard in research—to test the impact of depression screening and treatment. The study included 1,500 heart attack survivors from four U.S. health care systems, none of whom had ever been diagnosed with depression. Participants were randomly assigned to three intervention groups and followed for 1.5 years.
The first group, which included about one-third of participants, received comprehensive screening and treatment for depression. The screening included a short questionnaire to identify symptoms of depression. For those that had depression symptoms, their primary care doctor was notified for follow-up. Participants with depression were also connected with treatment, which included therapy and/or medication.
The second study group received a similar intervention but did not receive connection with treatment. The third group received standard care without any mental health screening or referrals.
Participants were 66 years old, on average, and two-thirds were men.
After 1.5 years, participants repeated questionnaires and researchers found no difference in quality of life among any of the groups. There was also no difference in depression-free days or mortality rates among participants, based on a secondary analysis.
According to authors, there are a number of explanations for the lack of difference. First, only 7% of participants screened reported symptoms of depression, which was a much lower rate than anticipated. Among those that were offered treatment, nearly one-quarter declined connection with a therapist or mental health provider. Together, these numbers made it difficult to detect any effect between study groups. Authors also note that differences in motivation, interest and engagement in treatment could affect outcomes and should be taken into consideration for future research.
While results don’t support universal depression screening among heart attack patients, experts encourage future research on the issue. Depression is associated with increased health risks and poorer outcomes, especially in heart patients. While there’s no question that depression treatment is important, identifying practical ways to improve outcomes and quality of life, particularly among heart attack survivors, is an important next step in research.