There is no evidence from randomized controlled trials that routine screening for depression improves depression or cardiac outcomes in patients with coronary heart disease, though treatment yields modest symptom reductions (effect size 0.20-0.38).
Systematic Review
Does routine depression screening and treatment improve depressive symptoms and cardiac outcomes in adult patients with cardiovascular disease?
Routine screening for depression in cardiovascular care is not supported by evidence showing it improves depression or cardiac outcomes, challenging current AHA recommendations.
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.
Thombs et al. (Mon,) conducted a systematic review in Coronary heart disease (CHD) and depression. Routine depression screening and treatment vs. No screening, placebo, or usual care was evaluated on Improvement in depression or cardiac outcomes due to screening. There is no evidence from randomized controlled trials that routine screening for depression improves depression or cardiac outcomes in patients with coronary heart disease, though treatment yields modest symptom reductions (effect size 0.20-0.38).