Patient Health Questionnaire-9 score and adverse cardiac outcomes in patients hospitalized for acute cardiac disease.


Journal Article

OBJECTIVE: The Patient Health Questionnaire-9 (PHQ-9) is increasingly used as a depression assessment tool in cardiac patients. However, in contrast to older depression instruments, there is little data linking PHQ-9 scores to adverse cardiac outcomes. Our goal was to evaluate whether higher PHQ-9 scores were predictive of subsequent cardiac readmissions among depressed patients hospitalized for an acute cardiac event. METHODS: Patients diagnosed with depression during hospitalization for acute coronary syndrome, heart failure, or arrhythmia were enrolled in a randomized depression management trial. Participants were administered PHQ-9 at enrollment, and data was collected regarding cardiac readmissions and mortality over the next 6months. To evaluate the independent association of PHQ-9 score with subsequent cardiac readmission, Cox regression analysis that included relevant sociodemographic and medical covariates was used. Survival analysis examining time to first event, stratified by quartile of initial PHQ-9 score, was performed using Kaplan-Meier curves and log-rank test for trend. Analyses were then repeated using a composite (cardiac readmission or mortality) outcome. RESULTS: Among 172 subjects, 62 (36.0%) had a cardiac-related rehospitalization. Higher initial PHQ-9 score predicted cardiac-related rehospitalization, independent of multiple relevant covariates (hazard ratio 1.09 [95% confidence interval=1.02-1.17]; p=0.015). On survival analysis, log-rank test for trend revealed a significant rise in event rates across increasing PHQ-9 quartiles (χ(2)=6.36; p=0.012). Findings were similar (p<.05) for the composite outcome. CONCLUSION: In depressed cardiac patients, each additional point on the PHQ-9 was independently associated with a 9% greater risk of cardiac readmission over the subsequent 6months.

Full Text

Duke Authors

Cited Authors

  • Beach, SR; Januzzi, JL; Mastromauro, CA; Healy, BC; Beale, EE; Celano, CM; Huffman, JC

Published Date

  • November 2013

Published In

Volume / Issue

  • 75 / 5

Start / End Page

  • 409 - 413

PubMed ID

  • 24182627

Pubmed Central ID

  • 24182627

Electronic International Standard Serial Number (EISSN)

  • 1879-1360

Digital Object Identifier (DOI)

  • 10.1016/j.jpsychores.2013.08.001


  • eng

Conference Location

  • England