Background of the problem: Patients with heart failure (HF) may have stressful lifestyle changes. Patients with HF in our clinic show signs and symptoms of depression but, often times have never been screened. In a literature review, depression was often undiagnosed. Patients with HF and depression had higher rates of morbidity and mortality compared to patients without depression. Assessment of depression can be completed by a psychologist/psychiatrist using specific criteria, or more simply, via a patient-reported outcome measure (survey).

Objective: Review current literature to determine the best depression screening tool for patients with heart failure.

Methods: The librarian at our hospital was consulted for the article search. The keywords and medical subject heading (MeSh) search terms were heart failure, depression, depression tools, depression screening. The inclusion criteria was as follows: research of patients with heart failure, included at least 2 depression screening tools, or was a systematic review or meta-analysis. The exclusion criteria are case study, depression tool was not assessed for its relationship to other depression measures, expert opinion/review paper, and editorial.

We used the PubMed as our search engine. We retrieved papers from the previous 5 years, then extended the search to 15 years as seminal work was completed (SADHART-CHF study).

We found 56 articles that related to our topic objective. We excluded 19 papers after initial review. In total 37 papers reviewed. However, all but 5 papers used only 1 depression tool or met exclusion criteria. Five papers reviewed on the topic objective

Outcomes: Of 5 reports, only 3 used 2+ depression tools that allowed us to determine if one method was best. The other 2 reports used 1 depression tool and patient interviews by experts to determine depression based on published criteria for DSM IV (diagnostic criteria for major depressive disorder and depressive episodes). When depression prevalence was compared, rates of depression were higher when using patient-reported depression survey tools.

Conclusion: 18 depression tools were used in the studies that were reviewed. More than 1 depression screening/assessment method was used to assess depression in only 5 published reports. No researchers used the same 2 assessment tools to learn if 1 was superior to another in identifying depression. Although we were unable to determine superiority; tool sensitivity varied among different research studies and when using DSM-III or IV criteria, depression rates were lower than when using survey tools.

Implications for nursing practice: Depression may be identified by survey during a clinic visit. Since no 1 survey was superior, ANY valid, reliable survey should be used; preferably one that has been used in patients with heart failure AND preferably, once that has consistent results based on DSM-IV depression criteria.

More research is needed to determine if 1 depression survey has higher precision than others, especially since some are less burdensome and since some led to higher depression rates than using DSM interview criteria. Many research papers were not contemporary (>10 years old). It is unknown if patients on current heart failure therapies have similar depression rates.

Lacy Kowalski MSN, APRN, RN

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