Brief Depression Screening with the PHQ-2 Associated with Prognosis Following Percutaneous Coronary Intervention with Paclitaxel-Eluting Stenting

BACKGROUND: Depression is associated with adverse prognosis in cardiac patients, warranting the availability of brief and valid instruments to identify depressed patients in clinical practice.

OBJECTIVES: We examined whether the two-item Patient Health Questionnaire (PHQ-2) was associated with adverse events in percutaneous coronary intervention (PCI) patients treated with paclitaxel-eluting stenting (using the continuous score and various cutoffs), overall and by gender.

DESIGN: Prospective follow-up study.

PARTICIPANTS: Consecutive PCI patients (n=796) seen at a university medical centre.

MEASUREMENTS: PHQ-2 at baseline. The study end-point was an adverse event, defined as a combination of death or non-fatal myocardial infarction (MI) at follow-up (mean of 1.4 years).

RESULTS: At follow-up, 47 patients had experienced an adverse event. Using the continuous score of the PHQ-2 and the recommended cutoff >= 3, depressive symptoms were not associated with adverse events (ps>0.05). Using a cutoff >= 2, depressive symptoms were significantly associated with adverse events (HR: 1.89; 95% CI: 1.06-3.35) and remained significant in adjusted analysis (HR: 1.90; 95% CI: 1.05-3.44). Depressive symptoms were associated with an increased risk of adverse events in men (HR: 2.69; 95% CI: 1.36-5.32) but not in women (HR: 0.76; 95% CI: 0.24-2.43); these results remained in adjusted analysis.

CONCLUSIONS: Depression screening with a two-item scale and a cutoff score of >= 2 was independently associated with adverse events at follow-up. The PHQ-2 is a brief and valid measure that can easily be used post PCI to identify patients at risk for adverse health outcomes.