Effects of depression screening on psychiatric outcomes in patients with acute coronary syndrome: Findings from the K-DEPACS and EsDEPACS studies.
BACKGROUND
It has been controversial whether routine screening for depression should be recommended in all patients with acute coronary syndrome (ACS) due to lack of evidence for psychiatric as well as for cardiac outcomes. This study aimed to evaluate the result of screening for treatment and subsequent treatment of depression on one-year psychiatric outcomes in ACS.


METHODS
At baseline 1152 patients with recently developed ACS were screened with the Beck Depression Inventory (BDI) and depressive disorder diagnoses were applied according to DSM-IV criteria. Of the 446 patients with depressive disorder, 300 were randomized to a 24-week double-blind trial of escitalopram or placebo, while the remaining 146 received conventional medical treatment only (MTO) without randomization. Of all baseline participants, 828 were followed up one year later. Psychiatric outcomes included BDI, Hamilton Depression Rating Scale (HAMD), Montgomery Asberg Depression Rating Scale (MADRS), Social and Occupational Functioning Assessment Scale (SOFAS) and the World Health Organization Disability Assessment Schedule-12 (WHODAS-12).


RESULTS
BDI screen-positive ACS patients showed worse one-year outcomes on MADRS, SOFAS, and WHODAS scores (p-values<0.01) compared to BDI screen-negative patients. Escitalopram treatment was associated with beneficial effects compared to placebo and MTO on one-year outcomes on HAMD, MADRS and SOFAS (p-values<0.01). Of patients screening positive on the BDI, those with depressive disorder treated with escitalopram had similar outcomes to those without depressive disorder.


CONCLUSIONS
Routine screening of depressive symptom in ACS patients is helpful to plan further management. Moreover, successive accurate diagnosis of depressive disorder with appropriated treatment is effective at least for psychiatric outcomes.
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea.
Hee-Ju
HJ
Kang
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Robert
R
Stewart
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea.
Kyung-Yeol
KY
Bae
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea.
Sung-Wan
SW
Kim
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea.
Il-Seon
IS
Shin
Department of Cardiology, Chonnam National University Medical School, Kwangju, Republic of Korea.
Young Joon
YJ
Hong
Department of Cardiology, Chonnam National University Medical School, Kwangju, Republic of Korea.
Youngkeun
Y
Ahn
Department of Cardiology, Chonnam National University Medical School, Kwangju, Republic of Korea.
Myung Ho
MH
Jeong
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea.
Jin-Sang
JS
Yoon
Department of Psychiatry, Chonnam National University Medical School, Kwangju, Republic of Korea. Electronic address: jmkim@chonnam.ac.kr.
Jae-Min
JM
Kim
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015283:Citalopram / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005500:Follow-Up Studies; D008403:Mass Screening / Q000379:methods; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
Acute coronary syndrome; Depressive disorder; Escitalopram; Psychiatric outcome; Screening