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Assessment and follow-up of suicidal ideation when screening for depression in hospitalized coronary heart disease patients – development of a protocol

Katja Beer, Nina Rieckmann, Mira Ertl, Laura Grosse, Thorsten Zeidler, Volker Arolt, Wilhelm Haverkamp, Johannes Waltenberger, Jacqueline Müller-Nordhorn, Andreas Ströhle


Rationale, aims and objectives: Depression is common in coronary heart disease (CHD) patients and routine depression screening is often performed in research settings and recommended for clinical practice. Many depression screening instruments contain an item assessing suicidal ideation. A positive answer for suicidal ideation requires timely follow-up evaluation by trained clinicians; however, the process of transferal of this information is not without its problems. We aimed to develop and implement a step-by-step action protocol for the timely follow-up evaluation of positive screenings for suicidal ideation in hospitalized CHD patients who complete a depression screening in a research study.
Method: The protocol was developed by a team of psychiatrists and psychologists as part of a two-site prospective cohort study which includes 1265 hospitalized CHD patients with and without co-morbid depression. Patients were presented with two depression screening instruments as part of the baseline assessment, the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). All participants underwent a standardized computer based evaluation for clinical depression, anxiety and post-traumatic stress disorder using the Composite International Diagnostic Interview (CIDI). The protocol was adapted continuously with the aims to optimize information transfer between study team and clinic staff and to initiate potentially required care.

Results: The protocol was adapted to site-specific exigencies, resulting in a stepped approach of handling suicidal ideation, starting with suicidality assessment in a depression screening questionnaire. In case of positive screening, a detailed procedure for following-up on suicidal ideation was developed, including guidelines for various eventualities. In case of insufficient or doubtful distance from suicidal intent as assessed by clinical psychologists in training, psychiatric consultation was initiated.

Conclusions:Implementation of a protocol to follow-up on a positive suicidality screening in a research setting at two coronary care hospital sites was a logistical challenge, but proved feasible and acceptable to patients and staff.


suicidal ideation; suicidal intent; depression screening; coronary heart disease; myocardial infarction; patient health questionnaire

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