Objective: Depression is a very common disorder in patients with an acute coronary syndrome (ACS). Evaluating depression in patients with ACS in clinical settings is complicated by the lack of uniform criteria in choosing the appropriate instruments and the appropriate time of assessment of depressive symptoms. The aim of this review is to examine the performance of the instruments utilized to assess depression in patients with an ACS in a primary care setting.
Methods: We identified studies published between 1990 and 2010 that used standardized validated questionnaires to assess depression.
Results: Of the studies reviewed, 85% assessed depression within a week of hospitalization for ACS. Sensitivity ranged from 75% in the Hospital Anxiety Depression Scale to 88% in the Beck
Depression Inventory (BDI) and Patient Health Questionnaire (PHQ-9). Specificity ranged from 62% for the Geriatric Depression Scale to 88% for the PHQ-9.
Conclusions: This review suggests that the PHQ-9 is the most effective instrument for primary care settings due to its high sensitivity (88%) and specificity (89%). In a screening process, a scale with high sensitivity but low specificity will yield more false positives, whereas a scale with low sensitivity high specificity will yield a higher number of false negatives. In the case of choosing a screening tool to assess depression in patients with ACS, advantages and disadvantages should be considered, especially the trade-off between sensitivity (true positives) and specificity (false positives).
Keywords: Cardiovascular, depression, measurement, primary care, scales, Acute coronary syndrome, Mental Disorders, cardiac symptoms, bipolar disorder, psychoses, coronary artery disease, cardiovascular disease, mood disorder
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