Screening for depressive symptoms in cardiovascular patients at a tertiary centre in Trinidad and Tobago: investigation of correlates in the SAD CAT study

Abstract

Background This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients’ demographics, comorbidities, and cardiovascular medications with depressive symptoms. Methods In this observational, cross-sectional study, 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). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher’s exact test, Chi-square test, and multivariate logistic regression. Results The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) 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 depressive symptoms (p-value < 0.001). Conclusions Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. Trial Registration ClinicalTrials.gov number, NCT03863262. This trial was retrospectively registered on 20th February 2019.

Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

“…This study revealed a significantly higher risk of depression among females than males, which is concordant with previous studies' findings [ 33 , 37 , 38 , 64 , 65 ]. Some studies reported a 1.7-fold higher incidence and prevalence in women [ 66 , 67 ].…”

Implications for Self-Management among African Caribbean Adults with Noncommunicable Diseases and Mental Health Disorders: A Systematic Review

“…Three synthesized themes were identified: (1) prevalence of comorbid mental health problems and chronic NCDs ( n = 10); [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]; (2) factors that mitigate or mediate the association between mental health problems and chronic NCDs ( n = 11) [ 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 34 ]; —(2a) factors influencing self-management ( n = 4); [ 26 , 27 , 29 , 30 ]; (2b) association between mental health and NCD outcomes—studies focused on (2b1) risk factors ( n = 9) [ 23 , 24 , 25 , 26 , 27 , 28 , 31 , 32 , 33 ]; and (2b2) protective factors ( n = 3); [ 24 , 31 , 33 ]; and (3) varied results ( n = 3) [ 27 , 28 , 29 ]. The results are summarized in Table 4 .…”

“…Comorbid poor mental health and chronic NCDs were reported throughout the literature, with 7 out of 14 studies reporting a statistically significant association between mental health problems (e.g., depression) and comorbid NCDs in African Caribbeans [ 21 , 22 , 23 , 24 , 25 , 26 , 30 ]. Stewart et al reported a strong association between depression and physical illness and subsequent disability (e.g., stroke) in the African Caribbean population (OR = 2.48) [ 20 ].…”

“…These results were mirrored by Watkins et al, as they revealed that the odds of having more than one comorbid chronic NCD were greater for African Caribbeans with major depressive disorder when compared to those without (OR = 3.66) [ 21 ]. Similarly, Seecheran et al outlined how the number of comorbid conditions in African Caribbean populations was positively correlated with major depressive disorder symptoms (OR = 1.125) [ 22 ]. Frederick and Maharajah explored the relationship between mental health measures and type 2 diabetes [ 23 ].…”

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study

“…Despite the relatively low prevalence of T2DM in this study (15%) compared with other local studies of bordering almost 50%, no adjusted analyses were performed to assess the effects of this metabolic condition on native CA size. 10 60 As aforementioned, T2DM is implicated in negative remodelling, resulting in smaller CA size and may allude to heterogeneous results. The study also did not adjust for cardiovascular medications, which may impact CA sizes, such as calcium channel blockers and long-acting nitrates.…”