Does Evidence Support the American Heart Association's Recommendation to Screen Patients for Depression in Cardiovascular Care? An Updated Systematic Review

Brett D. Thombs, Michelle Roseman, James C. Coyne, Peter de Jonge, Vanessa C. Delisle, Erin Arthurs, Brooke Levis, Roy Ziegelstein

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere52654
JournalPLoS One
Volume8
Issue number1
DOIs
StatePublished - Jan 7 2013

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American Heart Association
systematic review
Screening
heart
Depression
screening
signs and symptoms (animals and humans)
Coronary Disease
antidepressants
myocardial infarction
heart failure
Antidepressive Agents
placebos
psychotherapy
Randomized Controlled Trials
Heart Failure
Myocardial Infarction
Placebos
Therapeutics

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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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. / Thombs, Brett D.; Roseman, Michelle; Coyne, James C.; de Jonge, Peter; Delisle, Vanessa C.; Arthurs, Erin; Levis, Brooke; Ziegelstein, Roy.

In: PLoS One, Vol. 8, No. 1, e52654, 07.01.2013.

Research output: Contribution to journalArticle

Thombs, Brett D. ; Roseman, Michelle ; Coyne, James C. ; de Jonge, Peter ; Delisle, Vanessa C. ; Arthurs, Erin ; Levis, Brooke ; Ziegelstein, Roy. / Does Evidence Support the American Heart Association's Recommendation to Screen Patients for Depression in Cardiovascular Care? An Updated Systematic Review. In: PLoS One. 2013 ; Vol. 8, No. 1.
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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.",
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