Two-step screening for depressive symptoms and prediction of mortality in patients with heart failure

Kyoung Suk Lee, Debra K. Moser, Michele Pelter, Martha J. Biddle, Kathleen Dracup

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background Comorbid depression in patients with heart failure is associated with increased risk for death. In order to effectively identify depressed patients with cardiac disease, the American Heart Association suggests a 2-step screening method: administering the 2-item Patient Health Questionnaire first and then the 9-item Patient Health Questionnaire. However, whether the 2-step method is better for predicting poor prognosis in heart failure than is either the 2-item or the 9-item tool alone is not known. Objective To determine whether the 2-step method is better than either the 2-item or the 9-item questionnaire alone for predicting all-cause mortality in heart failure. Methods During a 2-year period, 562 patients with heart failure were assessed for depression by using the 2-step method. With the 2-step method, results are considered positive if patients endorse either depressed mood or anhedonia on the 2-item screen and have scores of 10 or higher on the 9-item screen. Results Screening results with the 2-step method were not associated with all-cause mortality. Patients with scores positive for depression on either the 2-item or 9-item screen alone had 53% and 60% greater risk, respectively, for all-cause death than did patients with scores negative for depression after adjustments for covariates (hazard ratio, 1.530; 95% CI, 1.029-2.274 for the 2-item screen; hazard ratio, 1.603; 95% CI, 1.079- 2.383 for the 9-item screen). Conclusions The 2-step method has no clear advantages compared with the 2-item screen alone or the 9-item screen alone for predicting adverse prognostic effects of depressive symptoms in heart failure.

Original languageEnglish
Pages (from-to)240-247
Number of pages8
JournalAmerican Journal of Critical Care
Issue number3
StatePublished - May 1 2017

Bibliographical note

Funding Information:
FINANCIAL DISCLOSURES This research was funded by grant RO1HL083176, Improving Self-Care Behavior and Outcomes in Rural Patients With Heart Failure, National Heart, Lung, and Blood Institute and the National Institute of Nursing Research; a National Research Foundation grant funded by the government of South Korea (MEST, 2016R1A2B4008495).

Publisher Copyright:
© 2017 American Association of Critical-Care Nurses.

ASJC Scopus subject areas

  • Critical Care


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