Depression screening instruments in post-ACS patients yield 70% to 100% sensitivity, specificity, and negative predictive values, while CBT plus antidepressants modestly improves psychosocial outcomes.
Systematic Review
Do depression screening instruments and treatments accurately diagnose and improve depression symptoms in adults within 3 months of an ACS event?
In post-ACS patients, depression screening tools show acceptable diagnostic accuracy, and combined CBT with antidepressants modestly improves psychosocial outcomes.
BACKGROUND: Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression. PURPOSE: To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles. STUDY SELECTION: English-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments. DATA EXTRACTION: 2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence. DATA SYNTHESIS: Evidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care. LIMITATION: Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest. CONCLUSION: Depression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).
Nieuwsma et al. (2017) conducted a systematic review in Post-Acute Coronary Syndrome Depression. Depression screening instruments and treatments vs. Usual care was evaluated on Diagnostic accuracy of depression screening tools and effectiveness of depression treatments. Depression screening instruments in post-ACS patients yield 70% to 100% sensitivity, specificity, and negative predictive values, while CBT plus antidepressants modestly improves psychosocial outcomes.