Diagnostic accuracy of self-rating scales for screening of depression in coronary artery disease patients.
OBJECTIVE
We evaluated the internal consistency and psychometric properties of the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory-II (BDI-II) for screening of major depressive episodes (MDE) in coronary artery disease (CAD) patients undergoing rehabilitation.


METHODS
Five-hundred and twenty-two consecutive CAD patients (72% men; mean age 58±9 years) attending a rehabilitation program 2 weeks after inpatient treatment for acute ischemic cardiac events completed the HADS depression subscale (HADS-D), HADS anxiety subscale (HADS-A) and the BDI-II. Interview outcome using the Mini International Neuropsychiatric Interview (MINI) for current MDE according to the DSM-IV-TR criteria was considered as the gold standard.


RESULTS
Fifty-six (11%) patients had a current MDE. The HADS-D, HADS-A, HADS-total and BDI-II had high internal consistency. Area under the ROC curve was the highest for the BDI-II followed by the HADS. Optimal cut-off values for screening of MDE were ≥5 for the HADS-D, ≥8 for the HADS-A and ≥14 for the HADS-total and for the BDI-II. At optimal cut-off values the BDI-II had slightly superior psychometric properties when compared to the HADS. However, positive predictive values were low for the HADS and for the BDI-II.


CONCLUSIONS
In CAD patients undergoing rehabilitation, the HADS and BDI-II had high internal consistency. Screening for MDE at optimal cut-off values the BDI-II was slightly superior when compared to the HADS. Positive predictive values for the BDI-II and for the HADS were low indicating that a large proportion of patients with positive screening results did not meet criteria for MDE.
Institute of Psychophysiology and Rehabilitation, Lithuanian University of Health Sciences, Palanga, Lithuania. a.bunevicius@yahoo.com
Adomas
A
Bunevicius
Margarita
M
Staniute
Julija
J
Brozaitiene
Robertas
R
Bunevicius
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis*; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires