Depression after cardiac hospitalisation: the identifying depression as a comorbid condition (IDACC) study

Abstract

Background: The Identifying Depression as a Comorbid Condition (IDACC) study aimed to identify depressive symptoms in hospitalised cardiac patients and support management of depression in general practice. Objective: This post hoc analysis of the IDACC trial examines the effectiveness and practicality of different forms of communication between hospital psychiatric services and general practitioners. Methods: We randomised 669 cardiac inpatients with depressive symptoms, identified with the Center for Epidemiological Studies Depression Scale (CES-D), to an intervention or usual care control group. Individual depression scores and depression management guidelines were sent to GPs of all intervention patients. Where possible, psychiatric advice was provided to the GP either by multidisciplinary enhanced primary care case conference or one-to-one telephone advice. Results: Multidisciplinary case conferences were implemented for only 24% of intervention patients. General practitioners received individual telephone advice in 40% of cases, and 36% received written information only. The psychiatrist telephone advice resulted in a significant reduction in the proportion of patients with moderate to severe depression 12 months after cardiac hospitalisation (19% vs. 35%). Discussion: Screening, combined with psychiatrist telephone advice to GPs, was simple to organise and effective in reducing depression severity after cardiac admission.