Psychological Medicine

Original Articles

Diagnosis and treatment of depression following routine screening in patients with coronary heart disease or diabetes: a database cohort study

C. Burtona1 c1, C. Simpsona1 and N. Andersona1

a1 Centre for Population Health Sciences, University of Edinburgh, UK


Background Depression is common in chronic illness and screening for depression has been widely recommended. There have been no large studies of screening for depression in routine care for patients with chronic illness.

Method We performed a retrospective cohort study to examine the timing of new depression diagnosis or treatment in relation to annual screening for depression in patients with coronary heart disease (CHD) or diabetes. We examined a database derived from 1.3 million patients registered with general practices in Scotland for the year commencing 1 April 2007. Eligible patients had either CHD or diabetes, were screened for depression during the year and either received a new diagnosis of depression or commenced a new course of antidepressant (excluding those commonly used to treat diabetic neuropathy). Analysis was by the self-controlled case-series method with the outcome measure being the relative incidence (RI) in the period 1–28 days after screening compared to other times.

Results A total of 67358 patients were screened for depression and 2269 received a new diagnosis or commenced treatment. For the period after screening, the RI was 3.03 [95% confidence interval (CI) 2.44–3.78] for diagnosis and 1.78 (95% CI 1.54–2.05) for treatment. The number needed to screen was 976 (95% CI 886–1104) for a new diagnosis and 687 (95% CI 586–853) for new antidepressant treatment.

Conclusions Systematic screening for depression in patients with chronic disease in primary care results in a significant but small increase in new diagnosis and treatment in the following 4 weeks.

(Received February 29 2012)

(Revised June 03 2012)

(Accepted June 07 2012)

(Online publication July 18 2012)

Key words

  • Antidepressant treatment;
  • coronary heart disease;
  • diabetes;
  • depression;
  • screening


c1 Address for correspondence: Dr C. Burton, Centre for Population Health Sciences, University of Edinburgh, Doorway 1 Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK. (Email: