TY - JOUR
T1 - Effects of screening for anxiety and depression in patients with ischaemic heart disease – a nationwide Danish register study
AU - Kruse, Marie
AU - Laudicella, Mauro
AU - Olsen, Kim Rose
AU - Zwisler, Ann Dorthe O.
AU - Helmark, Charlotte
AU - Pedersen, Susanne S.
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors acknowledge the University of Southern Denmark for an unrestricted grant covering access to data for this study. Funding from Helsefonden (grant # 19-B-0257) supported the work on the paper for authors MK, KRO and ML.
Publisher Copyright:
© Author(s) 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Aim: To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. Methods: We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015–2018 (N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. Results: Exposure to AD screening was lower for patients with low income (change in probability −0.67, 95% CI −0.76; −0.59), low education (change in probability −0.16, 95% CI −0.20; −0.13), and a high comorbidity burden (change in probability −0.09, 95% CI −0.10; −0.07). Screened patients had a lower conditional probability of AD treatment (change in probability −0.0061, p < 0.001) than non-screened patients. The patient’s GP also had an impact on the probability of being referred for AD treatment. Using an instrumental variable approach did not affect the results. Conclusions: Screening for AD was subject to selection at the patient level; patients at lower risk of AD had a higher probability of being screened. Hence, extending systematic screening to cover a larger population may not achieve a noticeable increase in the uptake of AD treatment if it is not supported by appropriate measures to reduce reverse selection into screening.
AB - Aim: To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. Methods: We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015–2018 (N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. Results: Exposure to AD screening was lower for patients with low income (change in probability −0.67, 95% CI −0.76; −0.59), low education (change in probability −0.16, 95% CI −0.20; −0.13), and a high comorbidity burden (change in probability −0.09, 95% CI −0.10; −0.07). Screened patients had a lower conditional probability of AD treatment (change in probability −0.0061, p < 0.001) than non-screened patients. The patient’s GP also had an impact on the probability of being referred for AD treatment. Using an instrumental variable approach did not affect the results. Conclusions: Screening for AD was subject to selection at the patient level; patients at lower risk of AD had a higher probability of being screened. Hence, extending systematic screening to cover a larger population may not achieve a noticeable increase in the uptake of AD treatment if it is not supported by appropriate measures to reduce reverse selection into screening.
KW - anxiety
KW - cardiac rehabilitation
KW - depression
KW - Ischaemic heart disease
KW - screening
KW - selection
KW - Depression/diagnosis
KW - Denmark/epidemiology
KW - Anxiety/diagnosis
KW - Comorbidity
KW - Humans
KW - Myocardial Ischemia/epidemiology
U2 - 10.1177/14034948221074972
DO - 10.1177/14034948221074972
M3 - Journal article
C2 - 35114856
AN - SCOPUS:85124293605
SN - 1403-4948
VL - 51
SP - 149
EP - 156
JO - Scandinavian Journal of Public Health
JF - Scandinavian Journal of Public Health
IS - 2
ER -