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Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review.
PLoS One 2013; 8(1):e52654Plos

Abstract

OBJECTIVES

To systematically review evidence on depression screening in coronary heart disease (CHD) by assessing the (1) accuracy of screening tools; (2) effectiveness of treatment; and (3) effect of screening on depression outcomes.

BACKGROUND

A 2008 American Heart Association (AHA) Science Advisory recommended routine depression screening in CHD.

METHODS

CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases searched through December 2, 2011; manual journal searches; reference lists; citation tracking; trial registries. Included articles (1) compared a depression screening instrument to a depression diagnosis; (2) compared depression treatment to placebo or usual care in a randomized controlled trial (RCT); or (3) assessed the effect of screening on depression outcomes in a RCT.

RESULTS

There were few examples of screening tools with good sensitivity and specificity using a priori-defined cutoffs in more than one patient sample among 15 screening accuracy studies. Depression treatment with antidepressants or psychotherapy generated modest symptom reductions among post-myocardial infarction (post-MI) and stable CHD patients (N = 6; effect size = 0.20-0.38), but antidepressants did not improve symptoms more than placebo in 2 heart failure (HF) trials. Depression treatment did not improve cardiac outcomes. No RCTs investigated the effects of screening on depression outcomes.

CONCLUSIONS

There is evidence that treatment of depression results in modest improvement in depressive symptoms in post-MI and stable CHD patients, although not in HF patients. There is still no evidence that routine screening for depression improves depression or cardiac outcomes. The AHA Science Advisory on depression screening should be revised to reflect this lack of evidence.

Authors+Show Affiliations

Department of Psychiatry, McGill University, Montréal, Quebéc, 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 available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

23308116

Citation

Thombs, Brett D., et al. "Does Evidence Support the American Heart Association's Recommendation to Screen Patients for Depression in Cardiovascular Care? an Updated Systematic Review." PloS One, vol. 8, no. 1, 2013, pp. e52654.
Thombs BD, Roseman M, Coyne JC, et al. Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review. PLoS ONE. 2013;8(1):e52654.
Thombs, B. D., Roseman, M., Coyne, J. C., de Jonge, P., Delisle, V. C., Arthurs, E., ... Ziegelstein, R. C. (2013). Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review. PloS One, 8(1), pp. e52654. doi:10.1371/journal.pone.0052654.
Thombs BD, et al. Does Evidence Support the American Heart Association's Recommendation to Screen Patients for Depression in Cardiovascular Care? an Updated Systematic Review. PLoS ONE. 2013;8(1):e52654. PubMed PMID: 23308116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review. AU - Thombs,Brett D, AU - Roseman,Michelle, AU - Coyne,James C, AU - de Jonge,Peter, AU - Delisle,Vanessa C, AU - Arthurs,Erin, AU - Levis,Brooke, AU - Ziegelstein,Roy C, Y1 - 2013/01/07/ PY - 2012/09/12/received PY - 2012/11/20/accepted PY - 2013/1/12/entrez PY - 2013/1/12/pubmed PY - 2013/7/3/medline SP - e52654 EP - e52654 JF - PloS one JO - PLoS ONE VL - 8 IS - 1 N2 - OBJECTIVES: To systematically review evidence on depression screening in coronary heart disease (CHD) by assessing the (1) accuracy of screening tools; (2) effectiveness of treatment; and (3) effect of screening on depression outcomes. BACKGROUND: A 2008 American Heart Association (AHA) Science Advisory recommended routine depression screening in CHD. METHODS: CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases searched through December 2, 2011; manual journal searches; reference lists; citation tracking; trial registries. Included articles (1) compared a depression screening instrument to a depression diagnosis; (2) compared depression treatment to placebo or usual care in a randomized controlled trial (RCT); or (3) assessed the effect of screening on depression outcomes in a RCT. RESULTS: There were few examples of screening tools with good sensitivity and specificity using a priori-defined cutoffs in more than one patient sample among 15 screening accuracy studies. Depression treatment with antidepressants or psychotherapy generated modest symptom reductions among post-myocardial infarction (post-MI) and stable CHD patients (N = 6; effect size = 0.20-0.38), but antidepressants did not improve symptoms more than placebo in 2 heart failure (HF) trials. Depression treatment did not improve cardiac outcomes. No RCTs investigated the effects of screening on depression outcomes. CONCLUSIONS: There is evidence that treatment of depression results in modest improvement in depressive symptoms in post-MI and stable CHD patients, although not in HF patients. There is still no evidence that routine screening for depression improves depression or cardiac outcomes. The AHA Science Advisory on depression screening should be revised to reflect this lack of evidence. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23308116/Does_evidence_support_the_American_Heart_Association's_recommendation_to_screen_patients_for_depression_in_cardiovascular_care_An_updated_systematic_review_ L2 - http://dx.plos.org/10.1371/journal.pone.0052654 DB - PRIME DP - Unbound Medicine ER -