Clinical outcomes associated with screening and referral for depression in an acute cardiac ward.

AIM: The aim of this paper is to describe the implementation of a depression screening and referral tool in two cardiac wards of a major metropolitan public hospital. The tool consisted of two sections: (1) screening for depression risk (Cardiac Depression Scale-5) and (2) consequential referral actions. BACKGROUND: Prior research has shown that depression in patients with heart disease is associated with significantly impaired quality of life, decreased medication adherence, increased morbidity and increased use of healthcare services. DESIGN: A prospective in-patient study design. METHOD: A consecutive sample of 202 patients admitted to either the cardiac medical (n = 145) or surgical (n = 57) wards of a major Melbourne metropolitan hospital were recruited into the study over an 18-week period. RESULTS: Just over half (54%) of the patients were identified as 'at risk' of depression. Of these, 19% were assessed as moderate risk and 35% high risk. Of those patients, 91% had the risk score documented in their medical history, 90% had engaged in discussions with clinicians regarding their risk score, 85% had their risk score communicated formally to the medical team and 25% were formally referred for appropriate follow-up - significantly more than prior to implementation of the screening and referral tool. CONCLUSIONS: By providing a formalised mechanism for detecting depression, documented screening and referral rates improved for those with comorbid depression and heart disease affording an opportunity for early intervention. These findings support a move towards integrated approaches to screening of depression to become standard practice in the acute cardiac setting. RELEVANCE TO CLINICAL PRACTICE: Such mechanisms also have the potential to initiate the development of new models of care that acknowledge the complexity of comorbid depression and heart disease and provide pathways from speciality to primary care which integrate the physical and psychosocial domains inclusive of screening, referral, systematic monitoring and streamlined behavioural and physical care.

Service use in consultation-liaison psychiatry: guidelines for baseline staffing.

OBJECTIVE: The aim of this study was to determine how referrals and clinical activity in consultation-liaison psychiatry (C-L) vary according to unit type and size, length of stay and psychiatric diagnosis, and to use these data to inform recommendations for the minimum levels of staffing required to conduct consultations in a general hospital. METHOD: Data were collected across three urban teaching hospitals over a 5-year period. The data included hospital admission data, referrals, psychiatric diagnosis, clinical contact time, clinical equivalent full time (EFT) and a measure of 'busyness'. RESULTS: Mean clinical staffing was 0.84 EFT per 100 beds. Services received a mean of 2.4 referrals per 100 hospital admissions. On average, each referral generated 3.9 contacts and a total contact time of 2.6 hours. The contact time was greater in patients with multiple psychiatric diagnoses as compared with a single or no diagnosis. CONCLUSION: In order to provide a minimum level of service for consultations to the expected range of serious and immediate psychiatric disorders present in the general hospital, a C-L service requires about 1.0 clinical EFT per 100 beds. For services to be able to address more complex elements of illness behaviour, provide education, conduct research, contribute to comprehensive care in specialist areas and undertake other liaison activities, greater and more multi-disciplinary EFT is required.

A Controlled Study of a Group Mindfulness Intervention for Individuals Living With Inflammatory Bowel Disease.

BACKGROUND: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a mindfulness-based intervention for patients with inflammatory bowel disease (MI-IBD). DESIGN: Treatment-as-usual control versus mindfulness-based stress reduction intervention. METHODS: Sixty patients participated in either the MI-IBD (n = 33) or treatment-as-usual group (n = 27) conditions. The MI-IBD consisted of an 8-week mindfulness-based stress reduction training group. Outcome measures were administered at baseline (before intervention), immediately after intervention, and 6 months after intervention. Primary outcomes included measures of quality of life, psychological distress (depression and anxiety), and mindfulness. Data for MI-IBD group participants also included weekly attendance, daily minutes meditated, and satisfaction with the program. RESULTS: There were no baseline differences between intervention and control groups on demographic variables or inflammatory bowel disease severity. Compared with the control group, the MI-IBD group reported significantly greater improvements in anxiety, quality of life, and mindfulness at after intervention, with reduction in depression and improvements in quality of life and mindfulness maintained at 6 months after intervention. CONCLUSIONS: Results demonstrate the feasibility, acceptability, and efficacy of a mindfulness intervention for patients with inflammatory bowel disease, with medium-to-large effects on psychological distress, quality of life, and mindfulness.