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

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

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.

Related collections

Most cited references 50

Record: found
Abstract: found
Article: not found

Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.

Lisa F. Berkman, James Blumenthal, Matthew Burg … (2003)

Depression and low perceived social support (LPSS) after myocardial infarction (MI) are associated with higher morbidity and mortality, but little is known about whether this excess risk can be reduced through treatment. To determine whether mortality and recurrent infarction are reduced by treatment of depression and LPSS with cognitive behavior therapy (CBT), supplemented with a selective serotonin reuptake inhibitor (SSRI) antidepressant when indicated, in patients enrolled within 28 days after MI. Randomized clinical trial conducted from October 1996 to April 2001 in 2481 MI patients (1084 women, 1397 men) enrolled from 8 clinical centers. Major or minor depression was diagnosed by modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and severity by the 17-item Hamilton Rating Scale for Depression (HRSD); LPSS was determined by the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Instrument (ESSI). Random allocation was to usual medical care or CBT-based psychosocial intervention. Cognitive behavior therapy was initiated at a median of 17 days after the index MI for a median of 11 individual sessions throughout 6 months, plus group therapy when feasible, with SSRIs for patients scoring higher than 24 on the HRSD or having a less than 50% reduction in Beck Depression Inventory scores after 5 weeks. Composite primary end point of death or recurrent MI; secondary outcomes included change in HRSD (for depression) or ESSI scores (for LPSS) at 6 months. Improvement in psychosocial outcomes at 6 months favored treatment: mean (SD) change in HRSD score, -10.1 (7.8) in the depression and psychosocial intervention group vs -8.4 (7.7) in the depression and usual care group (P<.001); mean (SD) change in ESSI score, 5.1 (5.9) in the LPSS and psychosocial intervention group vs 3.4 (6.0) in the LPSS and usual care group (P<.001). After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9%) and psychosocial intervention (75.8%). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the 3 psychosocial risk groups (depression, LPSS, and depression and LPSS patients). The intervention did not increase event-free survival. The intervention improved depression and social isolation, although the relative improvement in the psychosocial intervention group compared with the usual care group was less than expected due to substantial improvement in usual care patients.

0 comments Cited 265 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Depression and 18-month prognosis after myocardial infarction.

Nancy Frasure-Smith, François Lespérance, Mario Talajic (1995)

We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality. Two-hundred twenty-two patients responded to a modified version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) for a major depressive episode at approximately 7 days after MI. The Beck Depression Inventory (BDI), which measures depressive symptomatology, was also completed by 218 of the patients. All patients and/or families were contacted at 18 months to determine survival status. Thirty-five patients met the modified DIS criteria for major in-hospital depression after the MI. Sixty-eight had BDI scores > or = 10, indicative of mild to moderate symptoms of depression. There were 21 deaths during the follow-up period, including 19 from cardiac causes. Seven of these deaths occurred among patients who met DIS criteria for depression, and 12 occurred among patients with elevated BDI scores. Multiple logistic regression analyses showed that both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32 to 10.05; P = .012) and elevated BDI scores (odds ratio, 7.82; 95% CI, 2.42 to 25.26; P = .0002) were significantly related to 18-month cardiac mortality. After we controlled for the other significant multivariate predictors of mortality in the data set (previous MI, Killip class, premature ventricular contractions [PVCs] of > or = 10 per hour), the impact of the BDI score remained significant (adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09; P = .0026). In addition, the interaction of PVCs and BDI score marginally improved the model (P = .094). The interaction showed that deaths were concentrated among depressed patients with PVCs of > or = 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07; P or = 10 PVCs per hour. This result is compatible with the literature suggesting an arrhythmic mechanism as the link between psychological factors and sudden cardiac death and underscores the importance of developing screening and treatment programs for post-MI depression.

0 comments Cited 191 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research.

Anna Meijer, Henk Conradi, Elisabeth H. Bos … (2015)

A meta-analysis of over 25 years of research into the relationship between post-myocardial infarction (MI) depression and cardiac prognosis was conducted to investigate changes in this association over time and to investigate subgroup effects. A systematic literature search was performed (Medline, Embase and PsycINFO; 1975–2011) without language restrictions. Studies investigating the impact of post-MI depression on cardiovascular outcome, defined as all-cause mortality, cardiac mortality and cardiac events within 24 months after the index MI, were identified. Depression had to be assessed within 3 months after MI using established instruments. Pooled odds ratios (ORs) were calculated using a random effects model. A total of 29 studies were identified, resulting in 41 comparisons. Follow-up (on average 16 months) was described for 16,889 MI patients. Post-MI depression was associated with an increased risk of all-cause mortality [(OR), 2.25; 95% confidence interval [CI], 1.73-2.93; P<.001], cardiac mortality (OR, 2.71; 95% CI, 1.68–4.36; P<.001) and cardiac events (OR, 1.59; 95% CI, 1.37-1.85; P<.001). ORs proved robust in subgroup analyses but declined over the years for cardiac events. Post-MI depression is associated with a 1.6- to 2.7-fold increased risk of impaired outcomes within 24 months. This association has been relatively stable over the past 25 years. Copyright © 2011 Elsevier Inc. All rights reserved.

0 comments Cited 158 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Jerson Laks: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 7 January 2013

Volume: 8

Issue: 1

Electronic Location Identifier: e52654

Affiliations

[1 ]Department of Psychiatry, McGill University, Montréal, Quebéc, Canada

[2 ]Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebéc, Canada

[3 ]Department of Medicine, McGill University, Montréal, Quebéc, Canada

[4 ]Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada

[5 ]School of Nursing, McGill University, Montréal, Quebéc, Canada

[6 ]Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada

[7 ]Behavioral Oncology Program, Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennyslvania, United States of America

[8 ]Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

[9 ]Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

[10 ]Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

Federal University of Rio de Janeiro, Brazil

Author notes

* E-mail: brett.thombs@ 123456mcgill.ca

Competing Interests: The authors have read the journal's policy and have the following conflicts: Drs. Thombs and Ziegelstein were authors of a study on the diagnostic accuracy of depression screening tools that was included in this systematic review. Dr. de Jonge was an author of two studies on the treatment of depression. No other authors have any conflicts of interest to declare. No authors have any relationship to industry. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Conceived and designed the experiments: BT MR JC PD RZ. Performed the experiments: BT MR VD EA BL. Analyzed the data: BT MR. Wrote the paper: BT MR. Revised manuscript critically: BT MR JC PD VD BL EA RZ. Approved final manuscript for submission: BT MR JC PD VD BL EA RZ.

Article

Publisher ID: PONE-D-12-27966

DOI: 10.1371/journal.pone.0052654

PMC ID: 3538724

PubMed ID: 23308116

SO-VID: d6b76fac-71ae-42ea-a5eb-b7c670f760aa

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 12 September 2012

Date accepted : 20 November 2012

Page count

Pages: 13

Funding

This research was supported by a grant from the Canadian Institutes for Health Research (KRS 111754). Dr. Thombs is supported by a New Investigator Award from the Canadian Institutes of Health Research and an Établissement de Jeunes Chercheurs award from the Fonds de la Recherche en Santé Québec. Ms. Roseman is supported by a Master's Training Award from the Fonds de la recherche en santé Québec, a McGill University Provost's Graduate Fellowship and a McGill University Principal's Graduate Fellowship. Ms. Delisle is supported by a Master's Training Award from the Fonds de la recherche en santé Québec, and McGill University Graduate Studies Fellowship. Dr. Ziegelstein is supported by the Miller Family Scholar Program of the Johns Hopkins Center for Innovative Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Read this article at

Abstract

Objectives

Background

Methods

Results

Conclusions

Related collections

PLOS: COVID-19 pandemic

Most cited references 50

Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.

Depression and 18-month prognosis after myocardial infarction.

Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Comments

Comment on this article

Similar content 114

Cited by 42

Most referenced authors 844