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. 2013;8(1):e52654.
doi: 10.1371/journal.pone.0052654. Epub 2013 Jan 7.

Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review

Brett D Thombs  1 , Michelle Roseman, James C Coyne, Peter de Jonge, Vanessa C Delisle, Erin Arthurs, Brooke Levis, Roy C Ziegelstein
Affiliations

Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review

Brett D Thombs et al. PLoS One. 2013.

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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Conflict of interest statement

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.

Figures

Figure 1
Figure 1. PRISMA Flow Diagram of Study Selection Process for Key Question #1.
Figure 2
Figure 2. PRISMA Flow Diagram of Study Selection Process for Key Question #2.
Figure 3
Figure 3. Forest Plot of Effect Sizes of Depression Treatment Studies (Key Question #2).
Figure 4
Figure 4. PRISMA Flow Diagram of Study Selection Process for Key Question #3.
See this image and copyright information in PMC

References

    1. Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, et al. (2006) Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 21 1: 30–38. - PMC - PubMed
    1. Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, et al. (2011) Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis of 25 years of research. Gen Hosp Psychiatry 33 3: 203–216. - PubMed
    1. Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, et al. (2008) Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Circulation. 118 17: 1768–1775. - PubMed
    1. Wilson JM, Jungner G (1968) Principles and practices of screening for disease. Geneva: World Health Organization.
    1. Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, et al. (2008) Depression screening and patient outcomes in cardiovascular care: A systematic review. JAMA 300 18: 2161–2171. - PubMed

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