Coronary artery diseaseScreening for Depression in Patients With Coronary Heart Disease (Data from the Heart and Soul Study)
Section snippets
Study participants
The Heart and Soul Study is a prospective cohort study of psychosocial factors and health outcomes in patients who have CHD. Methods have been previously described.3 In brief, administrative databases were used to identify outpatients who had documented coronary artery disease at 2 Department of Veterans Affairs medical centers (Veterans Affairs Medical Center, San Francisco and the Veterans Affairs Palo Alto Health Care System, Palo Alto, California), 1 university medical center (University of
Results
Our sample of outpatients who had CHD consisted mostly of older men who were a mean age of 67 years (Table 1). Of the 1,024 participants, 224 (22%) had major depression as determined by the criterion standard computerized version of the Diagnostic Interview Schedule. Overall, the screening instruments had sensitivities of 39% to 90% and specificities of 69% to 92% using standard cutpoints (Table 2). Areas under the receiver-operating characteristic curves were similar for all screening tests,
Discussion
We found that a simple 2-item instrument was an effective tool for identifying major depression in patients who had CHD and had similar test characteristics to 3 other more time-consuming screening instruments for depression. A “no” response to the 2 items made depression highly unlikely, with a negative likelihood ratio of 0.14 and a posterior probability of 4%. Our results suggest that a simple 2-item instrument can be used to screen for depression in a diverse population of patients who have
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This study was supported by grants from the Department of Veterans Affairs, Washington, DC; the American Federation for Aging Research (Paul Beeson Scholars Program), New York, New York; the Robert Wood Johnson Foundation (Faculty Scholars Program), Princeton, New Jersey; and the Ischemia Research and Education Foundation, South San Francisco, California.