Date Available

12-7-2018

Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carol Thompson

Clinical Mentor

Dr. Lacey Buckler

Committee Member

Dr. Rebecca Dekker

Abstract

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to implement depression screening with the Patient Health Questionnaire-9 (PHQ-9) among patients with Coronary Heart Disease (CHD) who have undergone a Coronary Artery Bypass Graft (CABG) and demonstrate the feasibility of a nurse-led Cognitive Behavioral Therapy (CBT) intervention.

METHODS: A non-experimental pre-test and post-test design was completed to screen for depression among patients post CABG in the Cardiovascular Intensive Care Unit (CVICU) at a University Hospital using the PHQ-9. A sample of 21 patients were identified and selected from a convenience sample by pulling every eligible record from Institutional Review Board (IRB) approval date. An evidence-based non-pharmacological (CBT) intervention for depressive symptoms was provided to patients with a PHQ-9 score of 5 or greater. Patients who received the CBT intervention were re-evaluated for depressive symptoms with the PHQ-9 at two weeks post CABG. Follow-up care or referral was offered by the provider as appropriate if the patient continued to screen positive for depression after CBT intervention.

RESULTS: A total of 38% (8 out of 21) screened positive for depression. Of 8 patients total that screened positive for depression, 62.5% (5 out of 8) were re-screened post CBT-intervention from which 60% (N = 3) had lower PHQ-9 scores indicating reduced depressive symptoms. There was 1 patient death, 1 patient decline and 1 patient lost to follow-up. The paired t-test analysis examining the difference in PHQ-9 scores at pre- and post-CBT was not significant; however, this feasibility project was not powered to detect pre- and post-CBT differences in depression scores. Related to limited sample size, statistical significance was not shown (P=0.55). Yet, the intervention was brief and acceptable to medically fragile patients. A large number of patients had the following comorbidities: 57.14% had Type 2 Diabetes, 38.1% Myocardial Infarction, 28.57% Heart Failure, 25% pre-existing depression, 85.71% Hypertension, 90.48% Hyperlipidemia, 33.33% Chronic Obstructive Pulmonary Disease, 23.81% obesity, 19.05% anemia, and 19.05% anxiety. Another 33.33% had current tobacco use with 19.05% with former tobacco use. The preliminary findings from this project confirm the prevalence of depression defined in the literature and show upon analysis 60% of those screened for depressive symptoms who received intervention improved after CBT.

CONCLUSION: Depression screening is important because the prevalence of depression in patients post CABG in this project were on par with the national average rates of depression among heart disease patients who have had a CABG. The World Health Organization (WHO) has estimated that by the year 2020, that both CHD and depression will be the two major causes of disability-adjusted life years. The recommendation made by American Heart Association (AHA) to screen all patients with CHD should be established routinely. Depression screening and CBT are both feasible and do not require many resources. Implementation of depression screening in acute and outpatient settings may lead to adequate treatment as recommended by the AHA. The quality of life and lifespan for this cohort of patients may improve in addition to prevention of adverse health outcomes caused by untreated depressive symptoms including but not limited to increased mortality and even suicide from untreated depressive symptoms.

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