title: Using a single screening question for depressive symptoms in patients with acute coronary syndrome.
abstract: BACKGROUND
  Despite the prevalence of depressive symptoms and increased risk for future cardiovascular events, depressive symptoms frequently go underrecognized in patients hospitalized for acute coronary syndrome (ACS). Identifying an effective approach to depressive symptom screening is imperative in this population.
  
  
  OBJECTIVE
  The purpose of this cross-sectional study was to explore the agreement between Beck Depression Inventory-II (BDI-II) scores and a single screening question for depressive symptoms in 1122 patients hospitalized for ACS.
  
  
  METHODS
  Independent-samples t tests and χ tests were used to compare the groups with BDI-II scores of 14 or higher and lower than 14. Three separate agreement analyses were conducted using categorized BDI-II scores (≥14, ≥20, and ≥29). Agreement of the BDI-II categories with the responses to the single screening question was assessed with the simple κ statistic. Sensitivity and specificity were calculated using the BDI-II categories as the criterion standards for depressive symptom screening.
  
  
  RESULTS
  The agreement analysis revealed a moderate level of agreement (κ coefficient = 0.42) between the BDI-II scores of 14 or higher and the single screening question. Of the participants who reported a BDI-II score of 14 or higher, 61.65% answered yes to the single screening question (sensitivity, 0.62). For those who had BDI-II scores of lower than 14, a total of 82% responded no to the single screening question (specificity, 0.82). When using higher BDI-II scores to define depressive symptoms (≥20 and ≥29), the level of agreement decreased, whereas sensitivity increased to 0.76 and 0.90, with a trade-off in specificity (0.79 and 0.74, respectively).
  
  
  CONCLUSIONS
  These results suggest that the single screening question for depressive symptoms correctly identifies depressive symptoms 62% of the time but inappropriately identifies depressive symptoms 18% of the time in patients hospitalized for ACS. This suggests that the single screening question for depressive symptoms may be used with caution to initially screen patients with ACS, who can then undergo a more thorough assessment for clinical depression.
authors: Lorraine Frazier, PhD, RN, MS, FAHA, FAAN Dean and Professor, College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Jennifer Sanner, PhD, RN Assistant Professor, School of Nursing, Department of Nursing Systems, The University of Texas Health Science Center at Houston. Erica Yu, PhD, RN, ANP Assistant Professor, School of Nursing, Department of Acute & Continuing Care, The University of Texas Health Science Center at Houston. Stanley G. Cron, MSPH Research Instructor, School of Nursing, Center for Nursing Research, The University of Texas Health Science Center at Houston. F. Gerard Moeller, MD Professor of Psychiatry and Director, Center for Neurobehavioral Research on Addictions, The University of Texas Health Science Center at Houston.
authors: Lorraine
authors: L
authors: Frazier
authors: Jennifer
authors: J
authors: Sanner
authors: Erica
authors: E
authors: Yu
authors: Stanley G
authors: SG
authors: Cron
authors: F Gerard
authors: FG
authors: Moeller
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000523:psychology; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
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