Clinical assessment of depression by the attending medical team demonstrated low sensitivity (32%) and reasonable specificity (84%) compared to the PHQ9 questionnaire in ACS patients.
RCT (n=150)
Double-blind
Does clinical assessment by the attending medical team accurately detect depression compared to the PHQ9 questionnaire in patients admitted with acute coronary syndrome?
Clinical assessment by attending medical teams has low sensitivity for detecting depression in ACS patients, suggesting validated screening tools like the PHQ9 are necessary.
Depression commonly accompanies acute coronary syndrome (ACS), impacting up to 30% of patients and correlating with adverse outcomes. Our study aimed to assess the accuracy of clinical impression compared to the PHQ9 questionnaire for evaluating depression in ACS patients admitted to the cardiac intensive care unit. Screening for depression was conducted at least 48 hours from hospital admission and 24 hours following coronary angiography and PCI. The assessment was performed separately and in a blinded manner by the clinical assessment of the attending medical team and by the PHQ9 questionnaire. The study comprised 150 ACS patients with a mean age of 62 ± 13 years. Baseline clinical and demographic characteristics were typical for ACS patients. Based on the PHQ9 questionnaire, depressive symptoms were above the cutoff for clinical depression in 31 (20.7%) patients, with 10 (32.3%) of them experiencing moderate or severe depression (PHQ9 score >15). There were no significant differences in clinical baseline characteristics between the groups with and without clinical depression. Compared to the PHQ9 questionnaire, the medical team's assessment of depression demonstrated a reasonable specificity of 84% and low sensitivity of 32%. Negative and positive predictive values were 82.6% and 35.8%, respectively. Similar findings were observed in subgroup analyses according to gender, age, type of ACS, and history of cardiovascular disease. Depression is prevalent among ACS patients, highlighting the importance of an increased awareness of this condition. Our findings suggest that detecting clinically significant severity of depressive symptoms by the attending medical team alone may not suffice for depression assessment. Incorporating validated screening tools such as the PHQ9 questionnaire or involving psychological evaluations can enhance the accuracy of depression diagnosis in ACS patients. This multifaceted approach is crucial for ensuring comprehensive care and improving patient outcomes.
Giladi et al. (Tue,) conducted a rct in Acute coronary syndrome (n=150). Clinical assessment by attending medical team vs. PHQ9 questionnaire was evaluated on Accuracy of clinical impression compared to the PHQ9 questionnaire for evaluating depression. Clinical assessment of depression by the attending medical team demonstrated low sensitivity (32%) and reasonable specificity (84%) compared to the PHQ9 questionnaire in ACS patients.