Disparities in Depression Screening between Adults with versus without Congestive Heart Failure in the United States: A National Cross-Sectional Study

Abstract

Purpose In chronic heart failure (CHF), depression is often comorbid and leads to worse health outcomes. The purpose of this study is to characterize prevalence and factors related to depression and depression screening. Methods Prevalence of depression and depression screening were analyzed in adult outpatients from the 2006-2016 National Ambulatory Medical Care Survey. Additionally, data on age, sex, race, insurance, U.S. census region, specialty of doctor, depression, tobacco use, major reason for visit and comorbidities were analyzed. Multivariate logistic regression models were used to compare prevalence ratios, and weighting factors were applied to improve comparability and reduce bias. Results After adjustment, CHF positive patients were significantly more likely to have depression compared to CHF negative patients [1.1819 p=0.0017]. However, depression screening did not significantly differ [1.0663 p=0.6007]. For all patients, only approximately 3% received depression screening. When looking at only CHF positive patients, those with coronary artery disease, ischemic heart disease, a history of myocardial infarction, and depression were more likely to be screened but only around 41% of those patients are being screened. Those also seen by a primary care provider were less likely to be screened. When looking at major reasons for the visit, rates of depression screening did not differ among pre-surgery, post-surgery, and preventative care. Current tobacco use, diabetes, hyperlipidemia, obesity, and race are other potential modifying factors. Conclusion CHF positive patients experience higher rates of depression compared to their CHF negative counterparts, but do not have higher rates of depression screening by US providers. While primary care providers see the majority of CHF positive patients, they are less likely to provide depression screening. Patients with past depression or a history of other cardiovascular diseases are more likely to receive depression screening, but rates are still low. Other factors may be responsible for the disproportionate rates of depression screening among patients with CHF. These disparities among patient-centered care must be addressed to reduce comorbidities and improve health outcomes.