GP-psychiatrist liaison reduces depression severity in cardiac patients

Screening hospitalised cardiac patients for depression and providing psychiatric advice to their GPs leads to reduced depression severity 12 months post-discharge, say Australian researchers.The co-existence of depressive symptoms in patients with cardiovascular disease is well documented. In addition, it has been shown that the greater the severity of depression the greater the risk of adverse outcomes in coronary heart disease. Researchers in Adelaide conducted a randomised controlled study to investigate whether a simple intervention, delivered by GPs, might reduce severity of depression in patients hospitalised recently for cardiac disease. A total of 669 patients admitted to hospital for a cardiac condition, and identified as being depressed during their hospital stay, were included in the study. Patients were randomised to one of two groups: intervention by a GP; or usual care. The proportions of patients with mild or moderate to severe depression were similar in the two groups.Patients in the intervention group were referred to the psychiatric consultation liaison service for an in-hospital psychiatric consultation and were also seen independently by a cardiac rehabilitation nurse. GPs were then sent patients' depression rating scores and an evidence-based treatment guide, incorporating advice about recognising depression and available treatment options.GPs were offered a 15- to 30-minute telephone conference with the psychiatrist and the nurse who reviewed their patient. Alternatives included a standardised 5- to 10-minute telephone conference with a psychiatrist who had not seen their patient or written information only. Patients in the intervention group were less likely to have moderate to severe depression at 12 months post-discharge than those in the control group (25% versus 35%, relative risk = 0.72). The effect of the intervention was greatest in those with mild depression at baseline, suggesting that the intervention prevented progression to more severe disease. The standardised telephone conference with a psychiatrist was the only intervention associated with a significant reduction in the proportion of patients with moderate to severe depression. The study authors conclude that their findings have important implications for improving care for cardiac patients with co-morbid depression. They add that the intervention did not seem to be effective in reducing depression severity in patients with moderate to severe depression at baseline and that these patients may require more intensive support. Reference...