What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cardiovascular disease with depression or anxiety (n=66). Intervention: Patient-reported outcome measures (PROMs) for depression or anxiety. Primary outcome: Methodological quality, measurement properties, and certainty of evidence.

August 30, 2026Journal of Psychosomatic Research

Patient-reported outcome measures for depression or anxiety symptoms in patients with cardiovascular disease: A COSMIN systematic review

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Key result

Six depression and anxiety PROMs meet COSMIN Category A criteria for adults with CVD.

n=66

Why the study?

Depression and anxiety are common in patients with CVD, but the measurement quality of PROMs used in this population remains unclear.

Comparison

29 generic vs 9 CVD-specific PROMs

Design

COSMIN systematic review

Authors

SZShisen ZhaoSoochow University YLYuanyuan LiuSoochow University YJYang JuSoochow University

Discussion

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Implication

Supports adoption of validated depression and anxiety tools in cardiovascular care; extends psychometric evidence to this population.

Key Points

To evaluate the methodological quality, measurement properties, and certainty of evidence for depression and anxiety patient-reported outcome measures in adults with cardiovascular disease.
Conducted a systematic review across four databases from inception to February 2026 following COSMIN and PRISMA guidelines.
Evaluated methodological quality with the COSMIN Risk of Bias checklist and graded evidence certainty using an adapted GRADE approach.
Included 66 studies evaluating 38 PROMs (29 generic and 9 CVD-specific), with 6 instruments meeting COSMIN Category A criteria (CDS-SF, PHQ-9, BDI-II, HADS, GAD-7, and MDI).
Classified 4 instruments as Category C due to insufficient structural validity, while content validity was largely indeterminate or supported by limited certainty.
Identified that only 24 studies applied confirmatory factor analysis or Rasch analysis, and zero studies evaluated measurement error or responsiveness.

Study Design

Type

Systematic Review (n=66)

Structured PICO

Population

66 studies assessing 38 patient-reported outcome measures for depression and anxiety in adults with cardiovascular disease.

Exposure

Patient-reported outcome measures (PROMs) for depression or anxiety symptoms

Outcome

Methodological quality, measurement properties, and certainty of evidence for depression and anxiety PROMs

Six PROMs (including PHQ-9, BDI-II, HADS, and GAD-7) meet high methodological standards for assessing depression and anxiety in CVD patients, though further validation of content validity and responsiveness is needed.

Limitations

Content-validity evidence was largely indeterminate or of limited certainty.
Only 24 studies used confirmatory factor analysis or Rasch analysis.
No study assessed measurement error or responsiveness.
Cross-cultural validity evidence was scarce.
Content-validity evidence was largely indeterminate or of limited certainty
Only 24 studies used confirmatory factor analysis or Rasch analysis
No study assessed measurement error or responsiveness
Cross-cultural validity evidence was scarce

Cite This Study

Zhao et al. (2026) conducted a systematic review in Cardiovascular disease with depression or anxiety (n=66). Patient-reported outcome measures (PROMs) for depression or anxiety was evaluated on Methodological quality, measurement properties, and certainty of evidence. Six patient-reported outcome measures for depression and anxiety met COSMIN Category A criteria for use in adults with cardiovascular disease.

synapsesocial.com/papers/6a93e9db3affd7f5e23e6b4f https://doi.org/10.1016/j.jpsychores.2026.112971

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Patient-reported outcome measures for depression or anxiety symptoms in patients with cardiovascular disease: A COSMIN systematic review

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Patient-reported outcome measures for depression or anxiety symptoms in patients with cardiovascular disease: A COSMIN systematic review

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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