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

Naveen Seecheran, Cathy-Lee Jagdeo, Rajeev Seecheran, Valmiki Seecheran, Sangeeta Persad, Lakshmipatty Peram, Matthew Evans, Justine Edwards, Sheri Thackoorcharan, Britney Davis, Shari Davis, Barbrianna Dawkins, Anisha Dayaram, Michelle De Freitas, Tsarina Deonarinesingh, Jiovanna Dhanai, Cherelle Didier, Shastri Motilal, Nelleen Baboolal, Naveen Seecheran, Cathy-Lee Jagdeo, Rajeev Seecheran, Valmiki Seecheran, Sangeeta Persad, Lakshmipatty Peram, Matthew Evans, Justine Edwards, Sheri Thackoorcharan, Britney Davis, Shari Davis, Barbrianna Dawkins, Anisha Dayaram, Michelle De Freitas, Tsarina Deonarinesingh, Jiovanna Dhanai, Cherelle Didier, Shastri Motilal, Nelleen Baboolal

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.

Keywords: Cardiovascular disease; Depression; Patient health Questionnaire-9 (PHQ-9); Screening; Trinidad and Tobago.

Conflict of interest statement

The authors declare no competing interests.

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