January 7, 2013PLoS ONEOpen Access

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

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Coronary heart disease (CHD) and depression. Intervention: Routine depression screening and treatment vs. No screening, placebo, or usual care. Primary outcome: Improvement in depression or cardiac outcomes due to screening.

View Full Paper

Ask AI

Bookmark

Key result

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).

Why the study?

Does routine depression screening and treatment improve depressive symptoms and cardiac outcomes in adult patients with cardiovascular disease?

Population

Adult patients in cardiovascular care settings evaluated for depression screening accuracy or enrolled in…

Comparison

Depression screening tools and depression… vs For diagnostic accuracy: validated diagnostic…

Design

Systematic_review

Authors

BTBrett D. ThombsUniversity of North Carolina at Chapel Hill MRMichelle RosemanUniversity Health Network JCJames C. CoyneUniversity of Pennsylvania

Discussion

Member takes

Implication

Does not support routine depression screening in CHD; challenges AHA recommendations and prioritizes treatment-focused RCTs.

Study Design

Type

Systematic Review

Structured PICO

Does routine depression screening and treatment improve depressive symptoms and cardiac outcomes in adult patients with cardiovascular disease?

Population

A systematic review of studies evaluating the accuracy of depression screening tools, the efficacy of depression treatment, and the clinical impact of routine depression screening in patients with coronary heart disease.

Intervention

Depression screening tools (e.g., Beck Depression Inventory, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale) and depression treatment (antidepressants including citalopram, sertraline, mirtazapine, fluoxetine, or psychotherapy including cognitive behavior therapy and interpersonal therapy).

Comparator

For diagnostic accuracy: validated diagnostic interview for major depressive disorder (e.g., SCID, MINI). For treatment: placebo or usual care. For screening: no screening.

Outcome

Diagnostic accuracy of screening tools (sensitivity, specificity, positive predictive value, negative predictive value), effectiveness of treatment on depressive symptoms (Hedges's g) and cardiovascular outcomes, and effect of screening on depression outcomes.

Routine screening for depression in cardiovascular care is not supported by evidence showing it improves depression or cardiac outcomes, challenging current AHA recommendations.

Limitations

Heterogeneity in patient samples, screening tools, and treatments prevented quantitative pooling of results.
Risk of bias was unclear or high for many diagnostic accuracy studies due to lack of pre-specified cutoffs.
Most diagnostic studies did not exclude already diagnosed or treated patients, potentially exaggerating screening accuracy.
Risk of bias was unclear or high for 10 of 18 diagnostic articles that did not pre-specify a cutoff for the screening test
No diagnostic studies excluded already diagnosed or treated patients who would not be screened to identify new cases in clinical settings
Inability to blind participants and study personnel in trials that involved psychotherapy
Trials assessing cardiac outcomes had very low power

Cite This Study

Thombs et al. (2013) 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).

synapsesocial.com/papers/6a2a507ca94d6bc7baa23492 https://doi.org/10.1371/journal.pone.0052654

View Full Paper

Ask AI

Bookmark

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider