IMPLEMENTATION OF DEPRESSION SCREENING IN PATIENTS WITH CARDIOVASCULAR DISEASE

ABSTRACT Background: Patients with cardiovascular disease (CVD) have an increased risk of depression compared to the general population, yet depression screening rates in cardiology settings remain remarkably low. Cardiac clinics lack standardized screening protocols, leaving patients with undiagnosed and untreated depression that can worsen cardiovascular outcomes.Objective: This quality improvement (QI) project aimed to pilot depression screening process using the Patient Health Questionnaire-2 and 9 (PHQ-2 and PHQ-9) tools and management algorithm to improve identification of depression and mental health referrals in patients with CVD attending an outpatient cardiac clinic.Methods: This QI project was conducted over 10 weeks using the Institute for Healthcare Improvement Model for Improvement. Structured depression screening using the PHQ-2 and PHQ-9 tools was integrated into routine clinical workflow on one cardiologist's clinic days. Patients with CVD aged 18 years or older who were cognitively intact and English-speaking were included; exclusion criteria included current depression diagnosis, antidepressant use, acute decompensation, or recent screening. Four Plan-Do-Study-Act cycles monitored screening compliance, intervention delivery, and provider satisfaction. Results: Of 121 patients with CVD seen during implementation, 93 (76.9%) met inclusion criteria. Screening was completed for 82 (88.2%) of eligible patients, exceeding the 50% target. 14 patients (17.1%) had elevated depression scores (PHQ-9 ≥5); 5 patients (6.1%) scored ≥10 indicating moderate-to-moderately severe depression. All 5 (100%) patients received mental health referrals and contact information. Documentation and provider satisfaction were 100%.Conclusions: Integrating standardized depression screening into routine cardiovascular care is feasible and clinically valuable. This evidence-based model provides a framework for expanding depression screening across multiple providers this health system to improve mental health and cardiovascular outcomes.