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Screening of depression in cardiology: A study on 617 cardiovascular patients
Valentina Tesio1, Sebastiano Marra2, Stefania Molinaro3
1Department of Psychology, University of Turin, Via Po 14, 10123 Turin, Italy.
Insights
A cut-off score of 14 on the Hospital Anxiety and Depression Scale (HADS) effectively screens for depression in hospitalized cardiovascular disease (CVD) patients, including Acute Coronary Syndrome (ACS) and Chronic Coronary Artery Disease (CAD). This finding aids in timely treatment planning.
Area of Science:
- Cardiology
- Psychiatry
- Medical Screening Tools
Background:
- Depression screening is under-performed in cardiovascular disease (CVD) care.
- Optimal screening tool cut-offs for depression in CVD patients remain unclear.
Purpose of the Study:
- To determine the optimal cut-off value of the Hospital Anxiety and Depression Scale (HADS) for depression screening.
- To evaluate HADS performance in hospitalized Acute Coronary Syndrome (ACS) and Chronic Coronary Artery Disease (CAD) patients.
Main Methods:
- Receiver Operating Characteristics (ROC) curve analysis was used.
- The Montgomery-Asberg Depression Rating Scale (MADRS) served as the criterion standard.
- Accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for various HADS cut-offs.
Main Results:
- HADS demonstrated excellent/very good accuracy in both ACS (Area Under Curve=0.911) and CAD (AUC=0.893) groups.
- A HADS cut-off of 14 provided the best balance of sensitivity and specificity.
- This cut-off yielded high negative predictive values (95.5% for ACS, 92.4% for CAD).
Conclusions:
- A HADS cut-off of 14 is recommended for screening depression in hospitalized ACS and CAD patients.
- This facilitates prompt identification of patients needing further depression assessment.
- Early intervention can prevent adverse outcomes associated with depression in CVD.
Background:
Depression screening in the cardiovascular disease (CVD) care setting is under-performed, also because the issue of the optimal screening tools cut-off is still open. We analysed which HADS (Hospital Anxiety and Depression Scale) total score cut-off value shows the best properties in two groups of 357 Acute Coronary Syndrome (ACS) and 260 Chronic Coronary Artery Disease (CAD) hospitalized patients.
Methods:
A Receiver Operating Characteristics (ROC) curve was plotted for both groups using the Montgomery-Asberg Depression Rating Scale (MADRS) as the criterion. Accuracy, positive (PPV) and negative (NPV) predictive values were computed for different cut-off scores.
Results:
The ROC curves confirmed the excellent/very good accuracy of the HADS in both groups, with an area under the curve of 0.911 for the ACS and 0.893 for the CAD patients. The cut-off of 14 showed the best compromise between high sensitivity and good specificity in both groups, with high negative predicted values (95.5% and 92.4%, respectively).
Conclusion:
Using a cut-off value of 14, the HADS could be considered a good screening tool to identify hospitalized CAD and ACS patients requiring a more accurate depression assessment, in order to promptly plan the most appropriate treatment strategies and prevent the negative effects of depression in CVD patients.
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