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Depression screening and patient outcomes in cardiovascular care: a systematic review.
JAMA 2008; 300(18):2161-71JAMA

Abstract

CONTEXT

Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear.

OBJECTIVE

To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles.

STUDY SELECTION

We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes.

DATA EXTRACTION

Methodological characteristics and outcomes were extracted by 2 investigators.

RESULTS

We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively).

CONCLUSIONS

Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.

Authors+Show Affiliations

Department of Psychiatry, McGill University, Montréal, Québec, Canada. brett.thombs@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review
Systematic Review

Language

eng

PubMed ID

19001627

Citation

Thombs, Brett D., et al. "Depression Screening and Patient Outcomes in Cardiovascular Care: a Systematic Review." JAMA, vol. 300, no. 18, 2008, pp. 2161-71.
Thombs BD, de Jonge P, Coyne JC, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300(18):2161-71.
Thombs, B. D., de Jonge, P., Coyne, J. C., Whooley, M. A., Frasure-Smith, N., Mitchell, A. J., ... Ziegelstein, R. C. (2008). Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA, 300(18), pp. 2161-71. doi:10.1001/jama.2008.667.
Thombs BD, et al. Depression Screening and Patient Outcomes in Cardiovascular Care: a Systematic Review. JAMA. 2008 Nov 12;300(18):2161-71. PubMed PMID: 19001627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Depression screening and patient outcomes in cardiovascular care: a systematic review. AU - Thombs,Brett D, AU - de Jonge,Peter, AU - Coyne,James C, AU - Whooley,Mary A, AU - Frasure-Smith,Nancy, AU - Mitchell,Alex J, AU - Zuidersma,Marij, AU - Eze-Nliam,Chete, AU - Lima,Bruno B, AU - Smith,Cheri G, AU - Soderlund,Karl, AU - Ziegelstein,Roy C, PY - 2008/11/13/pubmed PY - 2008/11/19/medline PY - 2008/11/13/entrez SP - 2161 EP - 71 JF - JAMA JO - JAMA VL - 300 IS - 18 N2 - CONTEXT: Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. OBJECTIVE: To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings. DATA SOURCES: MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles. STUDY SELECTION: We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes. DATA EXTRACTION: Methodological characteristics and outcomes were extracted by 2 investigators. RESULTS: We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively). CONCLUSIONS: Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/19001627/Depression_screening_and_patient_outcomes_in_cardiovascular_care:_a_systematic_review_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2008.667 DB - PRIME DP - Unbound Medicine ER -