NEW ORLEANS — A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.
Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.
Using data from the Heart and Soul Study out of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from San Francisco-area outpatient clinics.
The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.
Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.
Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures. The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.
The instrument can be easily integrated into outpatient visits in the busiest practices, he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”
The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD. Study participants, whose mean age is 67, were recruited from the Veterans Affairs medical centers of San Francisco and Palo Alto, Calif., the University of California at San Francisco Medical Center, and nine public health clinics in the Community Health Network of San Francisco.