Screening for depression in cArDiovascular patients at a tertiary Centre in TrinidAd and Tobago: The SAD CAT study

Abstract

Objectives This was an observational, cross-sectional study aimed to screen cardiovascular patients for depression at a tertiary center in Trinidad and Tobago; and to determine any significant associations amongst patients’ demographics, comorbidities, and cardiovascular medications with depressive symptoms. Methods Patients (n=1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Results The study had a 96% respondent rate, whereby the average age was 62 years old. 47.5% were male, and 52.5% were female. 90.2% of the sample had cardiovascular disease. 25% of the sample had a PHQ-9 score of ≥ 10, with 19.3% having no depressive symptoms. Females, lower levels of education and income were found to be statistically significant at risk for depression (all p-values <0.001). Comorbidities associated with depression included hypertension, prior cerebrovascular events, chronic kidney disease and chronic obstructive pulmonary disease with odds ratios (OR) and 95% confidence intervals (CI) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depression (p-value <0.001). Conclusion 1 in 4 screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. The information acquired from this study may be useful in developing screening protocols that can positively impact adherence and possibly attenuate future events. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depression. Further studies are required to validate these findings (ClinicalTrials.gov number, NCT03863262).