Understanding the Management of Depression by Medical Trainees in Heart Failure Patients

From the 2023 HVPA National Conference

Akshay Chandora, BS in Biology (Morehouse School of Medicine), Hee Lee BS (Medical College of Georgia), Yuna Seo BS, Eric Chang MD, Kisha Burgess DO, Christabel Nyange MD, Adeyinka Adeniyi MD, Christine Charaf MD, MBA

It is estimated that 6 million Americans suffer from heart failure. Many of these patients will suffer from comorbidities such as depression leading to poorer outcomes. Due to the greater focus on their medical treatment of heart failure, patients with heart failure (PWHF) providers will ignore managing psychiatric comorbidities such as depression. However, when a holistic approach to treating PWHF is used, better outcomes ca n be achieved.

In this multi-institutional study, we surveyed used an anonymous questionnaire to survey medical trainees (medical students, interns, residents, fellows, PA students) at three institutions in the state of Georgia for how depression is managed in PWHF. Data was analyzed to identify barriers and create improve systems to identify and treat depression in PWHF.

Of the 112 responders, 102 trainees believed depression is underdiagnosed in PWHF. 110 trainees believed that PWHF would benefit from being screened for depression. 81 trainees believed that patients with depression are at greater risk of developing heart failure. 111 trainees believed it is important to incorporate depression screens for PWHF in clinics. Only 20 trainees (of the 112 responders) believed that male and female PWHF had an equal risk of developing depression. 111 trainees believed that depression had limited positive outcomes in PWHF. Of the 112 trainees, only 77 trainees felt somewhat or very comfortable with diagnosing and screening depression in heart failure patients. Only 16 trainees (of the 112 responders) had reported screening depression in PWHF more than 70% of the time. When questioned about what factors are limiting the ability of trainees to screen depression in PWHF, 55 trainees (of the 112 responders) answered that the limited time with patients prevented the proper screening of depression in these patients. When asked about how to improve depression screening, 60 trainees (of the 112 responders) suggested screening every PWHF with PSQ2/PSQ9.

Conclusions/Clinical Implications:
Many improvements are required to better assess and manage depression in PWHF by the medical trainee. In our study most trainees identified time as the greatest barrier to assessing depression in PWHF and most recommended screening all PWHF with PSQ2 and PSQ9 questions. Although lengthening the encounter time will allow trainees to better assess and mangage depression in PWHF, it does not provide a practical solution to the resource strained healthcare system. A more balanced solution will be introducing PSQ-9 surveys to PWHF once a year. There is a large majority of trainees in our study that believed there was a correlation of heart failure and depression but only 70% were comfortable managing depression in PWHF. Improving the comfort level of trainees through interventions such as individualized training courses building greater awareness of the symptoms and signs of depression in PWHF should be a focus of future QI studies.

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