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Psychosomatics 48:185-194, May-June
doi: 10.1176/appi.psy.48.3.185
© 2007 Academy of Psychosomatic Medicine
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Review

Performance Characteristics of Depression Screening Instruments in Survivors of Acute Myocardial Infarction: Review of the Evidence

Brett D. Thombs, Ph.D, Gina Magyar-Russell, Ph.D, Eric B. Bass, M.D., M.P.H, Kerry J. Stewart, Ed.D., Konstantinos K. Tsilidis, M.P.H., David E. Bush, M.P.H., James A. Fauerbach, Ph.D, Una D. McCann, M.D., and Roy C. Ziegelstein, M.D.

Received July 12, 2006; revised October 23, 2006; accepted October 26, 2006. From the Johns Hopkins University Evidence-Based Practice Center, the Dept. of Psychiatry and Behavioral Sciences, and the Dept. of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; the Dept. of Epidemiology and the Dept. of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Send correspondence and reprint requests to Brett D. Thombs, Ph.D., Institute of Community and Family Psychiatry, SMBD-Jewish Gen. Hosp., 4333 Cote Ste. Catherine Rd., Montreal, Quebec, H3T 1E4. e-mail: brett.thombs{at}mcgill.ca
© 2007 The Academy of Psychosomatic Medicine


  ABSTRACT

 
TOP
 ABSTRACT
INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Authors conducted a systematic review to assess performance characteristics of depression screening instruments after acute myocardial infarction (AMI). Among the seven studies identified, the Beck Depression Inventory (BDI) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS–D) were used most frequently. Studies were generally of low quality, and no screening instrument performed notably better than others. Future research should compare the BDI and the HADS–D with instruments such as the Patient Health Questionnaire (PHQ–9 and PHQ–2) in post-AMI patients, should attend to important elements of the screening process, including when, where, and how often to screen patients, and should evaluate serial screening.


  INTRODUCTION

 
TOP
 ABSTRACT
 INTRODUCTION
METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 
Major depression is present in approximately 20% of patients hospitalized with acute myocardial infarction (AMI).1 Symptoms of depression after AMI predict lower physical functioning,2 poorer quality of life,3 substantially higher healthcare costs,4 and increased cardiac morbidity.5,6 Some studies, however, have failed to find this association.7,8 A recent metaanalysis9 and systematic review10 each concluded that depression is associated with cardiac and all-cause mortality in post-AMI patients, after controlling for other predictors. The authors of another systematic review, however, concluded that quality issues, such as the use of measurement instruments not specifically validated in AMI patients, and insufficient power in many studies, make it difficult to draw unambiguous conclusions about the association of depression with post-AMI mortality.11

The American College of Cardiology/American Heart Association practice guidelines for AMI recommend that the psychosocial status of patients be evaluated, "including inquiries regarding symptoms of depression,"12 but they do not recommend specific procedures for assessing depression. Canadian Cardiovascular Society guidelines for AMI13 recommend that all patients with AMI be screened for depression with the Beck Depression Inventory (BDI),14 and the National Service Framework for Coronary Health Disease of the United Kingdom15 recommends that the Hospital Anxiety and Depression Scale (HADS)16 be used to screen for symptoms of depression. We recently reported in a systematic review that the BDI and the HADS Depression subscale (HADS–D) are the most commonly used methods to screen for symptoms of depression in studies of post-AMI patients.1 The weighted prevalence of significant symptoms of depression across studies, however, differs substantially when the screening uses standard cutoff scores on the BDI (≥10; 31.1%) as compared with the HADS–D (≥8, 15.5%; ≥11, 7.3%).1

Accurately assessing symptoms of depression can be difficult in patients hospitalized with AMI because of the overlap between somatic manifestations of depression and the physical symptoms of AMI or side effects of its treatment. Symptoms characteristically associated with depression, such as fatigue or loss of energy, anhedonia, changes in sleep patterns, changes in appetite, or poor concentration, may occur as a normal reaction to the AMI or the hospitalization itself.17–19 The difference in rates obtained when using the BDI and the HADS–D could reflect whether or not somatic symptoms are assessed. Among medically ill patients, diagnostic paradigms that do not include somatic symptoms tend to produce lower prevalence rates.20,21 The BDI includes 7 items related to somatic symptoms among its 21 items; conversely, the HADS–D includes 7 items, none of which relates to somatic symptoms.

No studies have systematically reviewed the psychometric properties of screening tools for depression after AMI. Only one review has evaluated depression screening instruments in a defined medical population, and it reported very limited psychometric data for patients with stroke.21 The high prevalence of depression in post-AMI patients and its relationship to important outcomes suggest that greater attention should be paid to the measurement characteristics of assessment tools in this population. Furthermore, measurement characteristics of depression screening instruments may differ in post-AMI patients, as compared with other patient groups, because of the specific circumstances surrounding the AMI, its treatment, and the acute hospitalization. A study by Strik et al.,22 for instance, comparing three standard depression measures in a post-AMI sample, found that cutoff points validated in other patient populations did not work well in this patient group. The present systematic review of the literature was done in order to 1) evaluate the performance characteristics (i.e., validity, reliability, sensitivity, and specificity) of screening instruments for depressive symptoms in post-AMI patients, both in the hospital and within 3 months of hospitalization, and 2) provide recommendations for the assessment of depressive symptoms in this population.


  METHOD

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
RESULTS
 DISCUSSION
 REFERENCES
 
The review was part of a comprehensive evidence report that addressed several different questions related to post-AMI depression (e.g., prevalence, association with morbidity and mortality, and treatment).10 Key aspects of the methods are summarized below.

Search Strategy
For the comprehensive evidence report,10 the MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE databases were searched for articles published between 1980 and March 2004. Search strategies and terms are found in Appendix 1. Manual searching was done on 16 selected journals (see Appendix 2) from October 2003 through April 2004 and on references of reviews and eligible articles. ProCite reference-management software was used to create a database of reference material identified through an electronic search for relevant guidelines and reviews, through discussions with experts, and through the article review process. The article search for the comprehensive evidence report was updated by an additional search of the same databases for articles reporting on psychometric performance that were published between March 2004 and November 2005.

Study Selection, Data Extraction, and Quality Assessment
Two investigators independently evaluated studies for inclusion, with discrepancies resolved by consensus. We included studies published since 1980 that reported psychometric data on a validated questionnaire used to assess symptoms of depression. When multiple articles were published on the same study cohort, the most relevant article was included. Articles were excluded if they consisted of case series or case reports, were not in English, if only a meeting abstract was provided, if depression was not measured by a validated method, or if the timing of the depression assessment relative to the AMI was not reported. Studies with mixed populations were eligible for inclusion if data on AMI patients were reported separately or if patients with AMI represented >50% of the sample. Studies that reported on the diagnostic accuracy of a screening instrument were included if they used standard or empirically-derived cutoff scores, but not if they used arbitrary cutoff scores without justification. Although studies have reported psychometric data on depression instruments with other coronary artery disease patient groups, we only included articles on AMI patients because of the focus of the comprehensive evidence report and because characteristics of hospitalized AMI patients may result in different measurement challenges, particularly because of the acute nature of the event. Author and journal names were not masked, since masking did not appear to influence inclusion and exclusion decisions.23

Two investigators independently extracted data, reconciling differences by face-to-face meeting. Data-extraction forms were developed from consensus among the investigative team regarding the items that were most important for describing the characteristics of each study and summarizing study results. The quality of evidence from studies was classified by use of a four-tiered system based on American Academy of Neurology guidelines,24 which graded the degree of potential bias in the findings from Class I (low) to Class IV (very high). Some studies that were included in this review were not designed specifically to assess performance characteristics of measurement instruments. Thus, quality grades were assigned on the basis of evidence regarding the usefulness of specific instruments as depression screening tools, rather than on the evidence quality of the overall study.

Instruments Used to Screen for Depression Post-AMI
For this review, we defined depression as "symptoms meeting established clinical threshold criteria for depression as measured by validated questionnaires or standardized psychiatric interviews."10 The present review was limited to self-report instruments, which are easy to administer and score and can provide a quick estimate of symptom number and severity. Although the inclusion criteria for the comprehensive evidence report refer to the use of "validated questionnaires," we recognize that most instruments used with post-AMI patients have been validated in a patient group other than patients with AMI or cardiovascular disease.

Definitions of Reliability and Validity
Screening instruments for depression should display adequate coverage of the full range of symptoms of depression, including the core symptoms of depressed mood and anhedonia; should assess suicidality; and should display adequate population-specific reliability and validity. Reliability in this context refers to the extent to which each item of the scale reflects the same construct (internal-consistency reliability) and the degree to which it produces the same score across administrations (test–retest reliability). Adequate construct validity is achieved if the instrument adequately covers the range of depressive symptoms (content validity), predicts depression status at a later time point (predictive validity), correlates with established measures of depression (convergent validity), and discriminates from constructs other than depression, such as anxiety (discriminant validity).25


  RESULTS

 
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 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
DISCUSSION
 REFERENCES
 
Search Results
The search process for the entire post-AMI depression review10 identified 3,770 unique titles. During the title and abstract reviews, 2,597 and 825 citations were excluded, respectively. Of the remaining articles that were deemed eligible for at least one of the six comprehensive review questions, five articles met inclusion criteria for this review of performance characteristics of depression-screening instruments.22,26,29 A subsequent, supplementary search, which was done to identify studies on psychometric properties published between March 2004 and November 2005, uncovered two additional articles.30,31

Characteristics of Studies
A summary of key aspects of the seven eligible studies is presented in Table 1. Included studies were published between 2000 and 2005. All of the studies included post-AMI patients exclusively. Two studies reported data on factor/construct validity;26,27 two on convergent validity;28,29 three on internal-consistency reliability;26,27,31 and two on diagnostic usefulness.22,30 Eligible studies reported psychometric data on the BDI,22,28 the HADS–D22,26,27,31 or overall HADS,30 the Symptom Checklist–90 Depression subscale (SCL-90–Dep),22,29 and the Zung Depression Scale (ZDS).29


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TABLE 1. Characteristics of Studies Reviewed



Six studies were conducted in Europe,22,26,27,29–31 and one was conducted in the United States.28 Four studies were multicenter studies.26,28,30,31 The mean age of participants ranged from 55 to 67 years. The data reported here from the ENRICHD study,32 which was designed to maximize diversity of participants, included 56% male and 66% white participants.28 The other study samples were between 63% and 81% men. Only two other studies provided data on race; they enrolled 94%30 and 100%22 white participants. Only one study reported cardiac risk factors,28 and none of the studies reported AMI characteristics such as Killip class or left-ventricular ejection fraction.

Of the seven studies reviewed, five were assigned a Class IV quality-of-evidence rating,26–29,31 and two were assigned a Class III rating.22,30 Reasons for low-quality grades included the lack of evidence directly addressing screening usefulness, relatively small sample sizes, the lack of representative samples, or failure to disclose the percentage of eligible patients recruited. One, which was, overall, a Class I study, received a Class IV rating for the purposes of this review because it only included patients with significant symptoms of depression or with low social support.28 In order to be of high quality, a study of diagnostic accuracy should include patients with and without the disease of interest. Practice guidelines recommend that studies of diagnostic accuracy that do not include a comparison group be graded Class IV.24

Validity of Depression Screening Instruments Post-AMI
Two studies26,27 examined the factor/construct validity of depression screening instruments in post-AMI patients. One of the studies examining the factor structure of the HADS used exploratory factor analysis (EFA),27 and the other used confirmatory factor analysis (CFA).26 In the EFA study, the HADS was administered within 24 hours of admission to the cardiac-care unit. In the CFA study, the HADS was administered at three separate time-points: 1 week, 6 weeks, and 6 months post-AMI. Both studies found that a 3-factor solution represented the data better than the 2-factor Depression and Anxiety factors proposed by the authors of the HADS.16 In each case, however, a single Depression factor represented by the items of the HADS–D was found to be distinct from two anxiety-related factors from the Anxiety subscale.

Two studies reported data on the convergent validity of the BDI, the ZDS, and the SCL-90–Dep.28,29 The ENRICHD investigators reported a Pearson correlation of 0.64 between the BDI and the Hamilton Rating Scale for Depression (Ham-D) at least 2 weeks post-AMI, close to the low end of findings reported in other clinical settings (0.61 to 0.87).28 Since all patients included in the analysis had significant symptoms of depression, however, the relatively low correlation may have been a result of a restricted range of scores on both the BDI and Ham-D. The second study reported Pearson correlation coefficients from 0.70 to 0.77 between the ZDS and the SCL-90–Dep across four time-periods post-AMI (1, 3, 6, and 12 months).29

Reliability of Depression Screening Instruments Post-AMI
Internal-consistency reliability for the HADS–D as measured by Cronbach {alpha} was 0.72 in a sample of 194 male and female patients assessed within 24 hours of admission for AMI.27 A second study of 335 male and female patients reported Cronbach {alpha} for the HADS–D as 0.76, 0.80, and 0.81 at 1 week, 6 weeks, and 6 months post-AMI, respectively.26 A third study reported a Cronbach {alpha} of 0.82 for the HADS–D measured 2 to 7 weeks post-AMI.31

Diagnostic Usefulness of Depression Screening Instruments Post-AMI
Two studies 22,30 assessed the diagnostic usefulness of depression screening instruments. One study reported on the diagnostic usefulness of the BDI, HADS–D, and SCL-90–Dep, as compared with a diagnosis of major depression or combined major or minor depression based on a physician-administered Structured Clinical Interview for DSM–IV (SCID–IV)33,34 1 month post-AMI.22 The number of patients in each analysis ranged from 179 to 199, depending on the measure. SCID–IV prevalence was 11.2% for major depression and 7.8% for minor depression, for a combined prevalence of 18.9%. Using standard cutoff scores for combined major or minor depression, a BDI score of ≥10 was 81.1% sensitive and 67.6% specific; a HADS–D ≥8 was 65.0% sensitive and 89.9% specific; and an SCL-90–Dep score ≥23 for men and ≥28 for women was 75.3% sensitive and 81.1% specific (Figure 1). For the purposes of the present study, corrected specificity and sensitivity figures for the HADS–D were provided by the authors of the original study and were used in our analyses (personal communication, December 16, 2005).


Figure 1
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FIGURE 1.  Sensitivity and Specificity for Combined Major and Minor Depression for the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, Depression Subscale (HADS–D), and the Symptom Checklist-90 for Depression (SCL-90–Dep), Based on Standard Cutoff Scores22

Standard cutoff scores for the SCL-90–Dep were ≥23 for men and ≥28 for women.


The authors of this study also reported results from empirically-derived cutoff points that were determined through visual assessment of receiver operating characteristic (ROC) curves. Empirically-derived cutoffs for combined major or minor depression were ≥8 for the BDI (sensitivity 83.8%, specificity 71.7%), ≥4 for the HADS–D (sensitivity 75.0%, specificity 77.6%), and ≥27 for the SCL-90–Dep (sensitivity 81.1%, specificity 83.5%; Figure 2). For major depression alone, empirically-derived cutoffs were ≥10 on the BDI (81.8% sensitivity, 78.7% specificity), ≥4 on the HADS–D (85.0% sensitivity, 74.8% specificity), and ≥25 on the SCL-90–Dep (95.5% sensitivity, 74.0% specificity; Figure 3).


Figure 2
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FIGURE 2.  Sensitivity and Specificity Data for Combined Major or Minor Depression, for the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, Depression Subscale (HADS–D), and the Symptom Checklist-90 for Depression (SCL-90–Dep), Based on Empirically-Derived Cutoff Scores22



Figure 3
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FIGURE 3.  Sensitivity and Specificity Data for Major Depression, Based on Empirically-Derived Cutoff Scores

Sensitivity and specificity data for major depression are depicted using empirically-derived cutoff scores for the Beck Depression Inventory, the Depression subscale of the Hospital Anxiety and Depression Scale, the Depression subscale of the Symptom Checklist-90,22 and for the overall Hospital Anxiety Depression Scale.30


The interpretability of these results from this study, however, is limited by non-uniform timing of assessments with the screening questionnaires. Patients in the study were evaluated with the SCID–IV at 1 month post-AMI. At the time of the evaluation, they were asked to fill out the BDI, the HADS–D, and the SCL–90 at home and then return them to the investigators. Patients who did not return the questionnaires within 2 weeks received a reminder phone call. The study did not report data on the delay between assessment with the SCID–IV and the return of the questionnaires. Thus, for an unknown proportion of patients, these results do not appear to represent concurrent sensitivity and specificity data. Also, the number of patients assessed varied across instruments. Given the relatively small number of cases identified by the SCID–IV in this study, it is possible that this could have had an impact on comparative sensitivity and specificity results.

A second study, which included 314 patients hospitalized for an AMI,30 reported good sensitivity (87.7%) and specificity (84.7%) for the overall HADS with an empirically derived cutoff of ≥18, as compared with a diagnosis of ICD-10 depressive disorder in the month before the AMI on the basis of the Schedule for Assessment of Neuropsychiatric Disorders35 (Figure 3). Assessments were done as soon as medically possible after the AMI (mean: 3.6 days post-AMI), and the prevalence of depressive disorder was 20.7%.


  DISCUSSION

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
REFERENCES
 
This is the first systematic review of the literature examining the psychometric properties of screening instruments for symptoms of depression in post-AMI patients. Only seven studies were identified that provided data on validity, reliability, or diagnostic-utility characteristics of depression-assessment tools in this population. Of these studies, however, most were carried out in relatively small samples, were generally of low quality, and provided limited information. Inconsistencies in results related to diagnostic usefulness from these studies highlight the shortcomings of the existing evidence-base. Strik et al.,22 for instance, reported empirically-derived cutoff scores for the SCL-90–Dep of ≥27 to screen for major or minor depression, but a lower threshold of ≥25 to screen for major depression alone. Also, Strik et al.22 reported that a score of ≥4 on the HADS–D maximized combined sensitivity and specificity, regardless of whether major depression or combined major and minor depression was being assessed. Across studies, the relatively low empirically-derived cutoff score of ≥4 on the 7-item HADS–D for major depression contrasts with the relatively high cutoff score of ≥18 on the overall 14-item HADS that Dickens et al.30 found to maximize diagnostic usefulness. Thus, it is difficult to conclude from the existing evidence that any one of the three instruments for which diagnostic-utility data were reported (the BDI, HADS, and SCL-90–Dep) performed better than the others. Notably, none of the cutoff points derived in studies included in this review were replicated through cross-validation procedures. Cutoffs generated from single samples tend to capitalize on chance and maximize sensitivity and specificity, and cross-validation is necessary before cutoffs can be accepted as useful in clinical practice.36,37

A recent review of evidence-based assessment methods for depression recommended that, among other characteristics, screening instruments should display adequate coverage of the full range of symptoms of depression, including the core symptoms of depressed mood and anhedonia; should assess suicidality; and should display adequate psychometric standards, including 1) internal consistency and test–retest reliabilities of at least 0.70; 2) evidence for construct validity; and 3) demonstration of psychometric properties in at least two samples.25

Consistent with values reported in studies of other medical populations,38 the HADS–D was found to have adequate internal-consistency reliability in three different samples of post-AMI patients.26,27,31 Also, two studies reported evidence for its construct validity as a measure of depression.26,27 The HADS–D, however, does not assess somatic symptoms of depression, does not screen for suicidality, and consistently identifies a relatively low percentage of post-AMI patients with a diagnosis of major depression.1 No studies have reported reliability data for the BDI with post-AMI patients, and only very limited convergent-validity data are available.28,29 The BDI, however, identifies approximately 30% of post-AMI patients as having at least mild-to-moderate symptoms of depression, somewhat higher than the approximately 20% with major depression,1 and it screens for suicidality, as well as for a full range of mood, cognitive, and somatic symptoms. No reliability data and only very limited validity data are available for the SCL-90–Dep with post-AMI patients.29 The SCL-90–Dep does, however, assess a range of symptoms, including dysphoric mood and affect, anhedonia, lack of motivation and energy, hopelessness, suicidality, and other cognitive and somatic aspects of depression.

The BDI and the HADS–D are the most commonly used methods to screen for symptoms of depression among post-AMI patients.1 Different guidelines have recommended each of these for this purpose,13,15 although comparative evidence regarding the usefulness of each screening measure among post-AMI patients is limited. By contrast, a great deal of work has been done on screening for depression in primary-care settings. A recent systematic review of case-finding instruments for identifying depression in primary care found 38 different studies of 16 different case-finding instruments that ranged in length from 1 to 30 questions, including the BDI, the HADS, and the SCL–90.39 The authors of the review reported that the median sensitivity and specificity for major depression were 85% and 74%, respectively, similar to values reported here for post-AMI patients. Notably, they found that there were no significant differences in accuracy across instruments. Within individual instruments, however, there was significant variation across studies, which is consistent with results reported here from post-AMI samples.

Limitations of this review include variations in the designs of the studies from which data were synthesized, including differences in study size, inconsistencies in in-hospital and follow-up assessment timing and in the relationship between the time of screening and diagnostic assessment, the overall low quality of the studies, and the high percentage of white men included each study, which may limit generalizability. The small number of studies reviewed did not allow for systematic review of potentially important factors, such as the exclusion of older patients29–31 or patients receiving psychiatric treatment.31 Also, the review did not include abstracts, nonpublished studies, or studies published in non–English-language journals. Furthermore, a stronger design for article review might have included measures of interrater reliability and the use of a third investigator to resolve any differences, rather than consensus by the initial two reviewers.

Practice guidelines recommend that physicians assess for depression among patients with AMI.12 Evidence from this review and from the larger literature on assessment of depression in primary care39 suggests that many different depression-screening tools will likely perform adequately, and no single instrument has been shown to clearly outperform the others. Healthcare workers in practice have limited time with each patient and are responsible for screening for a variety of different disorders and conditions. In this context, considerations such as instrument brevity, readability, and comprehensibility are of great importance. The BDI, HADS–D, and SCL–90 each include items with several different response options related to symptom severity, and item response options vary from item to item, increasing complexity for patients. Instruments that require only Yes/No responses or estimates of symptom frequency may be easier to administer or easier for patients to complete independently.39 The Patient Health Questionnaire–9 (PHQ–9) is a 9-item measure of depression severity that includes a user-friendly frequency-rating response format; it has been shown to be a highly sensitive (88%) and specific (88%) case-finding tool for depression among primary-care patients.40 The Patient Health Questionnaire–2 (PHQ–2) is an even briefer, two-item measure that is also sensitive (83%) and specific (92%) for major depression in primary care. Limitations in existing research on screening tools for depression among post-AMI patients, along with the user-friendly attributes and strong performance characteristics of instruments like the PHQ–9 and the PHQ–2 among primary-care patients suggest the need for further validation of case-finding instruments for post-AMI patients. Future research should compare the BDI and the HADS–D with the PHQ–9 and PHQ–2 and should attend to important elements of the screening process, including when, where, and how often to screen patients; whether patient characteristics such as age, gender, and race influence the accuracy of depression screening in the post-AMI setting; and whether serial screening with more than one instrument improves efficiency and accuracy.

In summary, identification of post-AMI patients with elevated symptoms of depression may provide an opportunity to improve overall medical care, as well as an opportunity to diagnose and treat a burdensome and important health condition. Large studies, such as SADHEART41 and ENRICHD,42 indicate that selective serotonin-reuptake inhibitors are a safe and potentially efficacious treatment for depression among patients with AMI. Thus, given the limited availability of psychiatry consultation, a reasonable strategy, although one that needs further research, would be to screen initially with one of several short screening tools1–3 items) that have been validated in primary-care settings,43,44 followed by a more thorough screening tool, such as the BDI, HADS–D, or PHQ–9, and referral for psychiatric consultation or to an affiliated mental health professional for patients with significant symptoms of depression.


  ACKNOWLEDGMENTS

 
This article is based on research conducted by the Johns Hopkins University Evidence-Based Practice Center under contract to the Agency for Healthcare Research and Quality (Contract No. 290-02-0018), Rockville, MD. The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Dept. of Health and Human Services.

We thank Captain Ernestine Murray for her support as the Task Order Officer for this project.


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APPENDIX 1. Literature Search Strategies




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APPENDIX 2. Journals Included in Hand Searching




  REFERENCES

 
TOP
 ABSTRACT
 INTRODUCTION
 METHOD
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Thombs BD, Bass EB, Ford DE, et al: Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006; 21:30–38[CrossRef][Medline]
  2. Ades PA, Savage PD, Tischler MD, et al: Determinants of disability in older coronary patients. Am Heart J 2002; 143:151–156[CrossRef][Medline]
  3. Ruo B, Rumsfeld JS, Hlatky MA, et al: Depressive symptoms and health-related quality of life: The Heart and Soul Study. JAMA 2003; 290:215–221[Abstract/Free Full Text]
  4. Frasure-Smith N, Lesperance F, Gravel G, et al: Depression and healthcare costs during the first year following myocardial infarction. J Psychosom Res 2000; 48:471–478[CrossRef][Medline]
  5. Lauzon C, Beck CA, Huynh T, et al: Depression and prognosis following hospital admission because of acute myocardial infarction. CMAJ 2003; 168:547–552[Abstract/Free Full Text]
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  9. van Melle JP, de Jonge P, Spijkerman TA, et al: Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004; 66:814–822[Abstract/Free Full Text]
  10. Bush DE, Ziegelstein RC, Patel UV, et al: Post-myocardial infarction depression. Evidence Report/Technology Assessment Number 123 (Prepared by The Johns Hopkins Univ. Evidence-Based Practice Center, contract 290-02-0018; AHRQ Pub. Number 05-E018–2 Rockville, MD, Agency for Healthcare Research and Quality, 2005
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  12. Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 2004; 44:E1-E211
  13. Fallen EL, Cairns J, Dafoe W, et al: Treatment of Patients With Myocardial Infarct: Consensus Report: Revision of the 1991 Guidelines Issued by the Canadian Society of Cardiology. Can J Cardiol 1995; 11:659–669[Medline]
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  20. Koenig HG, George LK, Peterson BL, et al: Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes. Am J Psychiatry 1997; 154:1376–1383[Abstract]
  21. Turner-Stokes L, Hassan N: Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway, part 1: diagnosis, frequency, and impact. Clin Rehabil 2002; 16:231–247[Abstract/Free Full Text]
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