title: Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review.
abstract: OBJECTIVE
  To systematically review evidence on depression screening in coronary heart disease (CHD) by assessing the (1) accuracy of screening tools; (2) effectiveness of treatment; and (3) effect of screening on depression outcomes.
  
  
  BACKGROUND
  A 2008 American Heart Association (AHA) Science Advisory recommended routine depression screening in CHD.
  
  
  METHODS
  CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases searched through December 2, 2011; manual journal searches; reference lists; citation tracking; trial registries. Included articles (1) compared a depression screening instrument to a depression diagnosis; (2) compared depression treatment to placebo or usual care in a randomized controlled trial (RCT); or (3) assessed the effect of screening on depression outcomes in a RCT.
  
  
  RESULTS
  There were few examples of screening tools with good sensitivity and specificity using a priori-defined cutoffs in more than one patient sample among 15 screening accuracy studies. Depression treatment with antidepressants or psychotherapy generated modest symptom reductions among post-myocardial infarction (post-MI) and stable CHD patients (N = 6; effect size = 0.20-0.38), but antidepressants did not improve symptoms more than placebo in 2 heart failure (HF) trials. Depression treatment did not improve cardiac outcomes. No RCTs investigated the effects of screening on depression outcomes.
  
  
  CONCLUSIONS
  There is evidence that treatment of depression results in modest improvement in depressive symptoms in post-MI and stable CHD patients, although not in HF patients. There is still no evidence that routine screening for depression improves depression or cardiac outcomes. The AHA Science Advisory on depression screening should be revised to reflect this lack of evidence.
authors: Department of Psychiatry, McGill University, Montréal, Quebéc, Canada. brett.thombs@mcgill.ca
authors: Brett D
authors: BD
authors: Thombs
authors: Michelle
authors: M
authors: Roseman
authors: James C
authors: JC
authors: Coyne
authors: Peter
authors: P
authors: de Jonge
authors: Vanessa C
authors: VC
authors: Delisle
authors: Erin
authors: E
authors: Arthurs
authors: Brooke
authors: B
authors: Levis
authors: Roy C
authors: RC
authors: Ziegelstein
mesh_terms: D000572:American Heart Association; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States
chemical_list: D000928:Antidepressive Agents