Assessment and follow-up of suicidal ideation when screening for depression in hospitalized coronary heart disease patients – development of a protocol

2015 ◽  
Vol 3 (4) ◽  
pp. 523 ◽  
Author(s):  
Katja Beer ◽  
Nina Rieckmann ◽  
Mira Ertl ◽  
Laura Grosse ◽  
Thorsten Zeidler ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Suicidal Ideation ◽  
Information Transfer ◽  
Depression Scale ◽  
Depression Screening ◽  
Care Hospital ◽  
Screening Instruments ◽  
Post Traumatic Stress

Rationale, aims and objectives: Depression is common in coronary heart disease (CHD) patients and routine depression screening is often performed in research settings and recommended for clinical practice. Many depression screening instruments contain an item assessing suicidal ideation. A positive answer for suicidal ideation requires timely follow-up evaluation by trained clinicians; however, the process of transferal of this information is not without its problems. We aimed to develop and implement a step-by-step action protocol for the timely follow-up evaluation of positive screenings for suicidal ideation in hospitalized CHD patients who complete a depression screening in a research study.Method: The protocol was developed by a team of psychiatrists and psychologists as part of a two-site prospective cohort study which includes 1265 hospitalized CHD patients with and without co-morbid depression. Patients were presented with two depression screening instruments as part of the baseline assessment, the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). All participants underwent a standardized computer based evaluation for clinical depression, anxiety and post-traumatic stress disorder using the Composite International Diagnostic Interview (CIDI). The protocol was adapted continuously with the aims to optimize information transfer between study team and clinic staff and to initiate potentially required care.Results: The protocol was adapted to site-specific exigencies, resulting in a stepped approach of handling suicidal ideation, starting with suicidality assessment in a depression screening questionnaire. In case of positive screening, a detailed procedure for following-up on suicidal ideation was developed, including guidelines for various eventualities. In case of insufficient or doubtful distance from suicidal intent as assessed by clinical psychologists in training, psychiatric consultation was initiated. Conclusions:Implementation of a protocol to follow-up on a positive suicidality screening in a research setting at two coronary care hospital sites was a logistical challenge, but proved feasible and acceptable to patients and staff.

scholarly journals Association of FKBP5 genotype with depressive symptoms in patients with coronary heart disease: a prospective study

2020 ◽  
Vol 127 (12) ◽  
pp. 1651-1662
Author(s):  
Julia Brandt ◽  
Katharina Warnke ◽  
Silke Jörgens ◽  
Volker Arolt ◽  
Katja Beer ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Depressive Symptoms ◽  
Coronary Revascularization ◽  
Central Element ◽  
Depression Scale ◽  
Stress System ◽  
Linear Regression Models ◽  
A Prospective Study

AbstractDepression and coronary heart disease (CHD) are prevalent and often co-occurring disorders. Both have been associated with a dysregulated stress system. As a central element of the stress system, the FKBP5 gene has been shown to be associated with depression. In a prospective design, this study aims to investigate the association of FKBP5 with depressive symptoms in CHD patients. N = 268 hospitalized CHD patients were included. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS-D) at four time points (baseline, and after 1 month, 6 months, and 12 months). The functional FKBP5 single-nucleotide polymorphism (SNP) rs1360780 was selected for genotyping. Linear regression models showed that a higher number of FKBP5 C alleles was associated with more depressive symptoms in CHD patients both at baseline (p = 0.015) and at 12-months follow-up (p = 0.025) after adjustment for confounders. Further analyses revealed that this effect was driven by an interaction of FKBP5 genotype with patients’ prior CHD course. Specifically, only in patients with a prior myocardial infarction or coronary revascularization, more depressive symptoms were associated with a higher number of C alleles (baseline: p = 0.046; 1-month: p = 0.026; 6-months: p = 0.028). Moreover, a higher number of C alleles was significantly related to a greater risk for dyslipidemia (p = .016). Our results point to a relevance of FKBP5 in the association of the two stress-related diseases depression and CHD.

scholarly journals Joint association between education and polygenic risk score for incident coronary heart disease events: a longitudinal population-based study of 26 203 men and women

2021 ◽  
pp. jech-2020-214358
Author(s):  
Pekka Martikainen ◽  
Kaarina Korhonen ◽  
Aline Jelenkovic ◽  
Hannu Lahtinen ◽  
Aki Havulinna ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Risk Score ◽  
Density Lipoprotein ◽  
Population Based ◽  
Polygenic Risk Score ◽  
Genome Wide ◽  
Increased Risk ◽  
Region Of Residence

BackgroundGenetic vulnerability to coronary heart disease (CHD) is well established, but little is known whether these effects are mediated or modified by equally well-established social determinants of CHD. We estimate the joint associations of the polygenetic risk score (PRS) for CHD and education on CHD events.MethodsThe data are from the 1992, 1997, 2002, 2007 and 2012 surveys of the population-based FINRISK Study including measures of social, behavioural and metabolic factors and genome-wide genotypes (N=26 203). Follow-up of fatal and non-fatal incident CHD events (N=2063) was based on nationwide registers.ResultsAllowing for age, sex, study year, region of residence, study batch and principal components, those in the highest quartile of PRS for CHD had strongly increased risk of CHD events compared with the lowest quartile (HR=2.26; 95% CI: 1.97 to 2.59); associations were also observed for low education (HR=1.58; 95% CI: 1.32 to 1.89). These effects were largely independent of each other. Adjustment for baseline smoking, alcohol use, body mass index, igh-density lipoprotein (HDL) and total cholesterol, blood pressure and diabetes attenuated the PRS associations by 10% and the education associations by 50%. We do not find strong evidence of interactions between PRS and education.ConclusionsPRS and education predict CHD events, and these associations are independent of each other. Both can improve CHD prediction beyond behavioural risks. The results imply that observational studies that do not have information on genetic risk factors for CHD do not provide confounded estimates for the association between education and CHD.

Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Daniel L Halberg ◽  
Charles Sands ◽  
Paul Muntner ◽  
Monika Safford
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

The long-term effect of physical activity on incidence of coronary heart disease: A 12-year follow-up study

2005 ◽  
Vol 41 (1) ◽  
pp. 219-225 ◽  
Author(s):  
Kristina Sundquist ◽  
Jan Qvist ◽  
Sven-Erik Johansson ◽  
Jan Sundquist
Keyword(s):  
Physical Activity ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Term Effect ◽  
Follow Up Study ◽  
Long Term Effect
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