title: Empirically derived psychometric screening for emotional distress in coronary artery disease patients: efficiency, efficacy, and source.
abstract: OBJECTIVE
  Multiple types of evidence implicate emotional distress as a cause of adverse outcomes in individuals with coronary artery disease. The present study was intended to determine the most accurate and user-friendly means of screening patients with coronary artery disease for emotional distress using age at initial diagnosis as the criterion.
  
  
  METHODS
  Two clinical databases consisting of patients with documented coronary artery disease, each contained multiple measures of emotional distress, were used. These databases were investigated by tests of covariation of the emotional distress measures with age at initial diagnosis. If these were statistically significant, sequential testing of cutpoints yielded the minimum score for positivity. Sensitivity, specificity, and positive predictive value calculations were made for the significant measures. Single-sex tests of covariation were also examined.
  
  
  CONCLUSIONS
  The Patient Health Questionnaire was the only significant bedside measure of emotional distress (Pearson r = -0.149, P = .058), with a cutpoint of 10 or greater. The Beck Depression Inventory, Hospital Anxiety and Depression Scale, and Crown-Crisp Phobic Anxiety Scale failed to reach significance as covariates of age at initial diagnosis. Substantially greater sensitivity occurs with larger and more cumbersome measures of emotional distress. For example, the Ketterer Stress Symptom Frequency Checklist yielded consistent results with greater variance explained, particularly in men (Pearson r for self-ratings of anger = -0.339, P = .001; depression = -0.363, P = .005; anxiety = -0.273, P = .028). Brief bedside/clinic screening of emotional in populations with coronary artery disease is possible and necessary to improve quality of life, compliance (eg, smoking cessation), and possibly morbidity/mortality. Initial screening can and should occur at the bedside/clinic by cardiology or primary care personnel using the Patient Health Questionnaire.
authors.affiliation: Heart & Vascular Institute, and Consultation/Liaison Psychiatry, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USA. MarkWKetterer@cs.com
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ketterer
authors.forename: Clinton A
authors.initials: CA
authors.lastname: Brawner
authors.forename: Melissa
authors.initials: M
authors.lastname: Van Zant
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Keteyian
authors.forename: Jonathon K
authors.initials: JK
authors.lastname: Ehrman
authors.forename: Walter
authors.initials: W
authors.lastname: Knysz
authors.forename: Amjad
authors.initials: A
authors.lastname: Farha
authors.forename: Sangita
authors.initials: S
authors.lastname: Deveshwar
authors.forename: Lawson
authors.initials: L
authors.lastname: Wulsin
mesh_terms: D001007:Anxiety; D003327:Coronary Disease / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation; D016208:Databases, Factual; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D004526:Efficiency; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011795:Surveys and Questionnaires