Symptoms of depression and anxiety are common in patients with cardiac disease (1, 2). Depressive symptoms are associated with increased mortality (3), reduced quality of life (4), increased use and increased cost of health services (5) and reduced opportunities for returning to work (6). According to the American Heart Association (7), depression is a negative prognostic factor at all stages of the disease (8). Depressive symptoms are also associated with other cardiac risk factors, such as smoking, poor diet and overweight, and predict reduced physical activity and poorer compliance with drug-based treatment regimens (9).
Depression is often a recurring disorder with onset during adolescence or early adulthood, and only a minority of the patients experience their first depressive episode in connection with the cardiac disease (10). Depression is therefore both a risk factor in a life-course perspective, in common with smoking, and a factor that may help trigger and exacerbate acute cardiac disease and reduce the patient's ability to cope with the illness. Anxiety disorders are associated with reduced quality of life after myocardial infarction, an unhealthy lifestyle and weakened compliance with treatment regimens (11). The risk may increase additively when depression and anxiety disorder coincide (12).
The American Heart Association (7) and European guidelines (13), including the National Institute for Health and Care Excellence (NICE) (14) and the Norwegian Directorate of Health (15), recommend procedures for screening for depression in cases of cardiac disease. There is sound evidence that treatment may improve mental health, functioning and quality of life (16, 17). A Cochrane review similarly concluded that a reduction in mortality from cardiac disease was possible, while pointing out that the evidence base here is uncertain (17). The American Heart Association (7) and the Norwegian Directorate of Health (15) recommend two screening questions for symptoms of depression, the Patient Health Questionnaire-2 (PHQ-2). These questions have been shown to be an independent predictor of mortality from heart failure up to four years after hospitalisation (18). NICE recommends screening with the use of two questions on symptoms of anxiety, the Generalized Anxiety Disorder Scale-2 (GAD-2) (19).
Although screening for symptoms of depression and anxiety is recommended in patients with cardiac disease, it is rarely done in practice. Experience from a study at the cardiology ward, Diakonhjemmet Hospital, where the nurses used the Patient Health Questionnaire-9 (PHQ-9) as a screening tool, indicated that screening is time-consuming in a busy hospital ward, and that the methods need to be simple (20). We wished to try out a simple procedure that involved oral questions, mainly asked by cardiologists. Moreover, we wished to screen outpatients, the largest group of patients in a cardiology department. Admitted patients were included a minimum of one month after discharge, not during hospitalisation as in the study referred to above (20). This was done to ensure that the reported symptoms of anxiety and depression were not overly influenced by ongoing stress during hospitalisation. The main objective was to assess a simple method for screening for symptoms of depression and anxiety among patients with cardiac disease.