Assessment of clinical depression metrics in cardiac patients using the patient health Questionnaire-9 before and after phase-II cardiac rehabilitation

Abstract

Cardiovascular disease remains a leading cause of morbidity and mortality, a fact that is commonly associated with co-morbidities such as clinical depression. While phase II cardiac rehabilitation is an established intervention for those with cardiovascular disease, its effect on patients who also suffer from depression are under studied.

Aim:

To quantify Pre- and Post-cardiac rehabilitation questionnaire scores collected from a large patient data registry. For this investigation, 27 ​670 patients completed Patient Health Questionnaire-9 questionnaires both Pre- and Post-rehabilitation (averaging [28.0 ​± ​8.7] phase II sessions). Findings reveal that questionnaire scores decreased by 40%-48% across all groups, a finding that was independent of assigned sex, race, and ethnicity. Moreover, when data were stratified for questionnaire scores that may indicate major and minor depressive disorder, phase II cardiac rehabilitation outcomes were lower by 61% and 49% respectively. While all groups exhibited lower questionnaire scores following cardiac rehabilitation participation, numerical differences at Pre- and Post-rehabilitation time points indicate that males and White patients have more favorable scores. This latter observation, while not confirmed currently, appears to be linked to referral rates to phase II cardiac rehabilitation, which remain poor for females, racial and ethnic minorities.

Keywords

Clinical depression / Exercise / Psychological health

Financial support

None to report.

Submission statement

All authors have read and agree with manuscript content. This manuscript has not been published elsewhere, and is not under current review at an alternative journal.

Ethical approval statement

Given the nature of the data registry, utilizing anonymized data input independent of patient files (excluding any patient identifiers), informed consent was not obtained for these data. However, data use agreements were obtained between the Montana Outcomes Project/the Montana Department of Health and Human Services prior to data upload to the registry. Separately, a data use agreement was obtained between the Montana Department of Health and Human Services and the University of Montana under the supervision and approval of the University of Montana Institutional Review Board.

Authors’ contributions

JCQ provided data interpretation, manuscript preparation, and editing. MM participated in study design, data interpretation, manuscript preparation, and editing. CO participated in study design, data analysis, data interpretation, manuscript preparation, and editing. CF participated in study design, data interpretation, manuscript preparation, and editing.

Conflict of interest

JCQ is an Editorial Board Member for Sports Medicine and Health Science and was not involved in the editorial review or the decision to publish this article. Otherwise, there are no conflicts of interest to report.

Acknowledgements

none to reportAll authors have read and approved the manuscript.

Special issue articles

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