title: Depression screening and patient outcomes in cardiovascular care: a systematic review.
abstract: BACKGROUND
  Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear.
  
  
  OBJECTIVE
  To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings.
  
  
  METHODS
  MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles.
  
  
  METHODS
  We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes.
  
  
  METHODS
  Methodological characteristics and outcomes were extracted by 2 investigators.
  
  
  RESULTS
  We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively).
  
  
  CONCLUSIONS
  Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.
authors.affiliation: Department of Psychiatry, McGill University, Montréal, Québec, Canada. brett.thombs@mcgill.ca
authors.forename: Brett D
authors.initials: BD
authors.lastname: Thombs
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.forename: Marij
authors.initials: M
authors.lastname: Zuidersma
authors.forename: Chete
authors.initials: C
authors.lastname: Eze-Nliam
authors.forename: Bruno B
authors.initials: BB
authors.lastname: Lima
authors.forename: Cheri G
authors.initials: CG
authors.lastname: Smith
authors.forename: Karl
authors.initials: K
authors.lastname: Soderlund
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008403:Mass Screening; D011569:Psychiatric Status Rating Scales
chemical_list: D000928:Antidepressive Agents