Depression Screening After a Heart Attack | Healos™
Depression After a Heart Attack: The Screening Question Your Cardiologist May Not Ask
Cardiology appointments are full of questions. How's the chest pain? Any breathlessness? Are you taking your medications? Here's one that's often missing: "How has your mood been?"
Today is World Mental Health Day, a good moment to ask it yourself.
Here is the short answer. Depression affects roughly one in five heart attack survivors, yet it's often missed in busy cardiology appointments. Two simple questions, the PHQ-2, can flag it in under a minute, and the nine-question PHQ-9 helps gauge severity. The American Heart Association has recommended routine screening since 2008. If your cardiologist doesn't ask, you can raise it yourself.
For the bigger picture of why depression is so common after heart and brain events, see depression after heart surgery, heart attack and stroke. This article is about the practical step: finding out, and saying it out loud.
简短的答案： 心脏科门诊充满了问题：胸痛怎么样？有没有气短？按时吃药了吗？但常常缺少一个：「最近心情怎么样？」今天是世界精神卫生日，正是自己问这个问题的好时机。约五分之一的心梗幸存者会出现抑郁，却常在忙碌的门诊中被漏掉；两个简单问题（PHQ-2）不到一分钟就能筛查，九题 PHQ-9 帮助判断严重程度；美国心脏协会自 2008 年起建议常规筛查。如果医生没问，你可以自己提出。关于心脑事件后抑郁为何如此常见的整体图景，请看我们的《三类术后抑郁》；本文讲的是实际一步：弄清楚，并说出来。
Why depression after a heart attack is so often missed
Roughly one in five heart attack survivors meets criteria for major depression (Thombs et al., Journal of General Internal Medicine, 2006), and the American Heart Association recognises depression as a risk factor for poorer outcomes after an acute coronary syndrome (Lichtman et al., Circulation, 2014). Yet it slips through for understandable reasons:
Symptoms overlap with recovery. Fatigue, poor sleep, low energy and poor concentration are blamed on the heart or the medications.
Appointments are short and focused on numbers, scans and prescriptions.
Patients don't volunteer it. Many people feel they should be grateful to be alive, or worry that admitting low mood looks weak.
Families notice, but don't know whether to say anything.
That's why the AHA recommended in 2008 that patients with coronary heart disease be routinely screened using simple questionnaires (Lichtman et al., Circulation, 2008).
为什么心梗后的抑郁常被漏掉： 约五分之一的心梗幸存者符合重度抑郁标准（2006），美国心脏协会也将抑郁认定为急性冠脉综合征后预后较差的风险因素（2014）。但它常常被漏掉，原因可以理解：
症状与康复重叠——疲劳、睡不好、精力不足、注意力差被归咎于心脏或药物；
门诊时间短，聚焦数字、影像和处方；
患者不主动说——觉得能活下来就该感恩，或担心承认情绪低落显得软弱；
家人察觉了，却不知道该不该开口。
所以 AHA 在 2008 年就建议对冠心病患者用简单问卷进行常规筛查。
The two-question screen: PHQ-2
The PHQ-2 asks about the past two weeks:
How often have you had little interest or pleasure in doing things?
How often have you been feeling down, depressed or hopeless?
Each is scored from 0 (not at all) to 3 (nearly every day). A total of 3 or more suggests it's worth completing the longer PHQ-9 and talking with your doctor. It takes less than a minute, and you can do it at the kitchen table.
两题筛查：PHQ-2： PHQ-2 询问过去两周：
① 做事时缺乏兴趣或乐趣的频率；
② 感到低落、抑郁或绝望的频率。
每题 0 分（完全没有）到 3 分（几乎每天），总分 3 分或以上，就值得填写较长的 PHQ-9 并与医生沟通。不到一分钟，在厨房桌边就能完成。
What your PHQ-9 score means
The PHQ-9 adds seven more questions, covering sleep, energy, appetite, concentration, feeling like a failure, moving or speaking slowly or restlessly, and thoughts that you'd be better off dead or of hurting yourself. Totals are commonly read as follows (Kroenke et al., Journal of General Internal Medicine, 2001):
0–4: minimal symptoms
5–9: mild
10–14: moderate
15–19: moderately severe
20–27: severe
A score is a starting point for a conversation, not a diagnosis. And one item matters regardless of the total: any thoughts of self-harm mean talking to someone now. In Canada and the US, call or text 988.
PHQ-9 分数代表什么：
PHQ-9 在此基础上增加七题，涵盖睡眠、精力、食欲、注意力、觉得自己失败、动作言语迟缓或坐立不安，以及「死了更好」或想伤害自己的念头。总分通常这样解读：
0–4 极轻微；
5–9 轻度；
10–14 中度；
15–19 中重度；
20–27 重度（2001）。
分数是对话的起点，不是诊断。有一题无论总分多少都很重要：只要有伤害自己的念头，就要立即找人谈。在加拿大和美国，请拨打或发短信至 988。
How to bring it up with your cardiologist or family doctor
If nobody asks, these words can open the door:
"I've been feeling low since the heart attack and I'm not sure if it's normal. Can we talk about it?"
"I did a PHQ-9 questionnaire and scored ___. What should I do next?"
"I'm sleeping badly and I've lost interest in things I used to enjoy. Could this be depression rather than my heart?"
It also helps to bring someone who's noticed the change, and to ask directly about options: talking therapy, a referral, support through cardiac rehab, or medication if appropriate. Many depression treatments are safe for heart patients, but never start or stop an antidepressant on your own. And if fear of another heart attack is part of the picture, mention that too (see heart attack PTSD).
怎么向心脏科或家庭医生开口： 如果没人问，这些话可以打开话题：
「心梗以后我一直情绪低落，不确定这正不正常，可以聊聊吗？」
「我做了 PHQ-9 问卷，得了 ___ 分，下一步该怎么做？」
「我睡不好，对以前喜欢的事也没兴趣了，会不会是抑郁而不是心脏的问题？」
带上察觉到变化的人一起去也有帮助，并直接询问选择：谈话治疗、转介、通过心脏康复获得支持，或适当时用药。很多抑郁治疗对心脏病人是安全的，但切勿自行开始或停用抗抑郁药。如果对再次心梗的恐惧也是其中一部分，也请说出来。
How Healos™ supports recovery
Healos™ doesn't diagnose or treat depression. It makes mood part of the recovery picture. The 91-Day Protocol moves through Clear, Replenish and Repair, providing complementary cellular nutrition and lifestyle support, with check-ins at days 30, 60 and 91 that track mood and sleep alongside activity and medications, so changes are visible to you and your care team. Sovereign Monthly · Recovery offers the same support month to month.
Healos™ 如何支持康复： Healos™ 不诊断或治疗抑郁，而是把情绪纳入康复全貌：91 天方案依次经过减负、补给、修复，提供辅助的细胞级营养与生活方式支持，并在第 30、60、91 天同时追踪情绪、睡眠、活动和用药，让变化对你和医疗团队都可见。Sovereign Monthly · Recovery 按月提供同样的支持。
The bottom line
After a heart attack, "How has your mood been?" is as important a question as "Any chest pain?", and it's often the one nobody asks. Two questions take less than a minute. If the answers worry you, write down your score, bring someone with you and say it out loud at your next appointment. On World Mental Health Day, or any day, that's a small step with a big effect on recovery.
结论： 心梗后，「最近心情怎么样？」和「有没有胸痛？」同样重要，却常常没人问。两个问题不到一分钟；如果答案让你担心，记下分数、带上家人，在下次复诊时说出来。无论是世界精神卫生日还是任何一天，这都是对康复影响很大的一小步。
Frequently asked questions
Should I be screened for depression after a heart attack? Yes. Roughly one in five heart attack survivors meets criteria for major depression, and the American Heart Association has recommended routine screening with simple questionnaires such as the PHQ-2 and PHQ-9.
What are the two questions used to screen for depression? The PHQ-2 asks how often, over the past two weeks, you've had little interest or pleasure in doing things, and how often you've felt down, depressed or hopeless. A total of 3 or more suggests completing the PHQ-9 and talking to your doctor.
What does my PHQ-9 score mean? Scores of 0–4 suggest minimal symptoms, 5–9 mild, 10–14 moderate, 15–19 moderately severe and 20–27 severe. A score starts a conversation; it isn't a diagnosis. Any thoughts of self-harm need attention right away.
How do I tell my cardiologist I feel depressed? Be direct: say you've been feeling low since the heart attack, share your PHQ-9 score if you have one, mention changes in sleep and interest, and ask about options such as therapy, a referral or support through cardiac rehab.
常见问题：
心梗后要做抑郁筛查吗？要，约五分之一符合重度抑郁标准，AHA 建议用 PHQ-2、PHQ-9 常规筛查。
两个筛查问题是什么？过去两周做事缺乏兴趣或乐趣、感到低落抑郁或绝望的频率，总分 3 分以上应做 PHQ-9 并告诉医生。
PHQ-9 分数含义？0–4 极轻微、5–9 轻度、10–14 中度、15–19 中重度、20–27 重度；有自伤念头需立即关注。
怎么跟心脏科医生说？直接说心梗后情绪低落，告知 PHQ-9 分数和睡眠兴趣变化，询问心理治疗、转介或心脏康复支持等选择。
References
Thombs BD, et al. Prevalence of depression in survivors of acute myocardial infarction. Journal of General Internal Medicine. 2006;21(1):30–38.
Lichtman JH, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment. A science advisory from the American Heart Association. Circulation. 2008;118(17):1768–1775.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606–613.
Lichtman JH, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome. Circulation. 2014;129(12):1350–1369.
