A meta-analysis published in the Annals of Internal Medicine reported that depression-screening instruments are as accurate in patients with post-acute coronary syndrome (ACS) as in other clinical populations. Furthermore, although depression interventions have an uncertain effect on cardiovascular outcomes, cognitive behavioral therapy (CBT) combined with antidepressant medication modestly improves psychosocial outcomes.
Evidence has shown that patients with ACS are at risk for a number of negative mental health consequences, including depression and major depressive disorder (MDD). In turn, patients with depression following ACS have an increased risk for death, making effective screening and treatment of this disorder essential.
Jason A. Nieuwsma, PhD, of Duke University School of Medicine, Department of Psychiatry and Behavioral Science, in Durham, North Carolina, and colleagues used MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systemic Reviews from January 2003 to August 2017 to evaluate the diagnostic accuracy of depression screening instruments and to compare the safety and efficacy of treatments in adults within 3 months of an ACS event. They only included English-language studies.
The researchers identified 6 studies relevant to depression screening and 4 relevant to treatment were identified, which evaluated the Beck Depression Inventory-II (BDI-II) (evaluated in 4 studies), the Hospital Anxiety and Depression Scale (HADS) (evaluated in 3), the Geriatric Depression Scale (GDS) (evaluated in 1), and the Patient Health Questionnaire PHQ) (evaluated in 1). These studies demonstrated that depression-screening instruments produced acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%), but low positive predictive values (below 50%). The 4 trials that evaluated depression treatment in patients post-ACS found statistically significant improvement in depressive symptoms in 3 of the studies, but this was of relatively little clinical significance. These studies compared usual care with either enhanced, team-based care that allowed for antidepressant therapy, psychotherapy, or both or sequenced CBT and antidepressant therapy.
Among the limitations of this meta-analysis are the limited number of studies, the absence of an evaluation of the influence of screening on clinical outcomes, and the absence of studies addressing several clinical interventions of interest. However, the investigators argue that implementing depression screening in patients post-ACS is reasonable given the known risk in this population.
Nieuwsma JA, Williams JW Jr, Namdari N, et al. Diagnostic accuracy of screening tests and treatment for post-acute coronary syndrome depression [published online November 14, 2017]. Ann Intern Med. doi:10.7326/M17-1811.