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VOLUME 8 NUMBER 2 • JUNE 2011
87
DIAGNOSING DEPRESSION
Perhaps, then, it is to do with practice nurses’ understanding and confi-
dence in diagnosing and treating depression? Responses to the survey
seem to support this view. Six out of 10 practice nurses said that they did
not feel confident in their understanding of the symptoms of depression;
most also stated that making a diagnosis of depression was complex. It
seems to us that these are important barriers to be overcome in order to
improve the recognition and treatment of depression in post-MI patients.
Turning to training, few of the survey respondents felt that they have
had adequate training in the diagnosis of depression. One competence
that might support clinicians to diagnose depression is the use of screen-
ing measures such as the PHQ-9. However, fewer than half of respond-
ents felt competent using depression screening tools in practice.
When we examined the impact of training on practice, we found that
nurses who had recently received education in depression tended to make
more time to talk with their patients about depression, were much more
likely to use screening tools and were more confident in making a diag-
nosis. To our mind, these findings indicated that providing primary care
nurses with focused training would improve the recognition and treatment
of depression in post-MI patients.
MANAGING DEPRESSION
When it comes to treating depression, practice nurses may be hesitant
about the use of antidepressants in post-MI patients because of the po-
tential for cardiac side-effects in some groups of drugs. However, the re-
sponses to our survey seemed to suggest that this was generally not the
case. Quite correctly, more than 90% of survey respondents considered
that antidepressant medication was safe and effective in depressed post-
MI patients, although two-thirds of you acknowledged the considerable
stigma that can be associated with taking these medicines.
Perhaps surprisingly, practice nurses taking part in the study were
much less positive about the place of cognitive behavioural therapy (CBT)
in depression treatment, with almost half of you rejecting this treatment as
not being as effective as medication. We wondered if this perhaps reflects
problems, which many of the survey respondents noted, in accessing this
form of treatment in primary care.
CONCLUSION
The results from this survey of primary care nurses underline the need for
more attention to be given to recognising depression in post-MI patients.
What struck us most from this survey was how many post-MI patients
with depression may be being missed, because of the underestimation of
the prevalence of the problem. Equipping practice nurses with the knowl-
edge and skills necessary to recognise depression seems to us to be
pivotal to improving detection rates and getting to grips with depression
post-MI. The benefits are well worth the effort, with the potential for better
outcomes for post-MI patients.
Prevention in Practice
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Table 2. Key findings from the survey
impact
•
The prevalence of depression after MI is largely underestimated
•
Practice nurses taking part in the survey acknowledge the negative impact
of depression on clinical outcomes
DIAGNOSIS
•
Two-thirds of practice nurses always use the ‘two question test’
•
60% of practice nurses responding to the survey do not feel confident in
their understanding of the symptoms of depression
•
Most practice nurses consider that the diagnosis of depression is complex
•
Fewer than half feel confident in the use of depression screening tools
such as the PHQ-9
•
Those who have received training feel more confident in the detection and
management of depression after MI
MANAGEMENT
•
Few of the survey respondents had received any training in the detection
and management of depression
•
Most practice nurses consider that antidepressants are safe after an MI
•
Half of practice nurses rejected the use of cognitive behavioural therapy
(CBT) as being less effective than antidepressants
Recommendations for practice: Improving management of
depression in post-MI patients
•
Raise awareness among patients and practitioners about the high
prevalence of depression after an MI
•
Encourage the use of the ‘two question test’ with all post-MI patients, in
every consultation
•
Improve the use of more detailed depression screening tools, such as the
PHQ-9
•
Increase access to training on the recognition and treatment of depression
for all primary care practitioners involved in the care of post-MI patients
•
Establish clear pathways for the treatment of depression after MI
•
British Association for Cardiac Rehabilitation
www.bcs.com
•
British Heart Foundation
www.bhf.org.uk
•
Patient UK
www.patient.co.uk
•
National Institute for Health and Clinical Excellence
www.guidance.nice.org.uk/
CG90
•
Living life to the full
www.livinglifetothefull.com
•
British Association of Psychopharmacology
www.bap.org.uk
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