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VIEWPOINT AND COMMENTARY

Routine Screening for Depression in Patients With Coronary Heart Disease

Never Mind

Roy C. Ziegelstein, MD^_*,_*, Brett D. Thombs, PhD, James C. Coyne, PhD and Peter de Jonge, PhD^,||

^_* Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Department of Psychiatry, McGill University and Sir Mortimer B. Davis–Jewish General Hospital, Montreal, Quebec, Canada
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Interdisciplinary Center for Psychiatric Epidemiology, Departments of Psychiatry and Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
^|| CoRPS–Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, the Netherlands

Manuscript received December 12, 2008; revised manuscript received January 20, 2009, accepted January 25, 2009.

^_* Reprint requests and correspondence: Dr. Roy C. Ziegelstein, Department of Medicine, B-1-North, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, Maryland 21224-2780 (Email: rziegel{at}jhmi.edu).

A recent Science Advisory from the American Heart Association (AHA) recommended routine screening of all patients with coronary heart disease (CHD) for depression. The authors of the advisory noted that the high prevalence of depression in patients with CHD supports this strategy. A systematic review of the evidence on depression screening and treatment in CHD patients published soon after the AHA advisory found that screening tools for major depression are reasonably accurate among patients with CHD, but that the majority of patients who screen positive will not have major depression; that depression treatment in CHD patients only accounts for a small amount of variance in depression symptom change scores; and that there is no evidence that screening for depression improves CHD outcomes. We call for the AHA to reassess their recommendations in light of this systematic review and considering the potential impact of their document on clinical practice.

Key Words: depression • screening • guidelines

Abbreviations and Acronyms   ACC = American College of Cardiology   AHA = American Heart Association   CHD = coronary heart disease   USPSTF = U.S. Preventive Services Task Force

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