Performance of Screening Tools in Detecting Major Depressive Disorder among Patients with Coronary Heart Disease: A Systematic Review

BACKGROUND: Major depressive disorder (MDD) is common in patients with coronary heart disease (CHD) and there is no consensus on the optimal screening tool for use in identifying MDD. This study aimed to systematically review the performance of various screening tools in the identification of MDD. MATERIAL/METHODS: Eligible studies published before 31 Dec 2013 were identified from the following databases: Ovid Medline, EMBASE, PsycINFO, Scopus, Cochrane Library, CINAHL Plus, and Web of Science. RESULTS: Eight studies aiming to identify MDD in CHD patients were included, and there were 10 self-reporting questionnaires (such as PHQ-2, PHQ-9, PHQ categorical algorithm, HADS-D, BDI, BDI-II, BDI-II-cog, CES-D, SCL-90, 2 simple yes/no items) and 1 observer rating scale (Ham-D). For MDD alone, the sensitivity and specificity of various screening tools at the validity and optimal cut-off point varied from 0.34 [0.19, 0.52] to 0.96 [0.78, 1.00] and 0.69 [0.65, 0.73] to 0.97 [0.93, 0.99]. Results showed PHQ-9 (≥10), BDI-II (≥14 or ≥16), and HADS-D (≥5 or ≥4) were widely used for screening MDD in CHD patients. CONCLUSIONS: There is no consensus on the optimal screening tool for MDD in CHD patients. When evaluating the performance of a screening tool, balancing the high sensitivity and negative predictive value (NPV) between specificity and positive predictive value (PPV) for screening or diagnostic purpose should be considered. After screening, further diagnosis, appropriate management, and necessary referral may also improve cardiovascular outcomes.