Abstract 2671: The Utility of Observer-Rater and Self-Report Instruments for the Detection of Major Depression in Women after Cardiac Surgery
Major depression (MD) is common after coronary artery bypass graft (CABG), particularly in women, and is linked to increased morbidity and mortality. Clinicians have few practical options to diagnose MD efficiently. Thus, we evaluated the clinical utility of common self-report and observer-rated instruments for MD screening in women after CABG.
Methods: In 66 women ready for hospital discharge after CABG (age 62.0 ± 9.7 years, 2.8 ± 0.9 grafts, 37% single, 27.3% with history of depression), diagnostic interviews based on DSM-IV criteria were conducted using the Diagnostic Interview and Structured Hamilton (DISH). Participants completed 2 instruments that evaluated both somatic and cognitive symptoms (Hamilton Depression Rating Scale [HDRS] and Beck Depression Inventory [BDI]) and 2 instruments including only cognitive symptoms (BDI-Short Form [BDI-SF] and BDI-Primary Care [BDI-PC]). Using the DISH as a “gold standard”, receiver operating characteristic (ROC) curve analyses were conducted to evaluate each instrument against DSM-IV criteria; sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) were calculated for cutoff points identified from each curve.
Results: Seven women (10.6%) met criteria for MD. All 4 instruments yielded highly accurate ROC curves (Area Under the Curve > .90, p < .001). Identified cutoffs yielded no false negatives (Table⇓). Compared to established cutoffs, they were higher for instruments with both somatic and cognitive symptoms. For instruments with only cognitive symptoms, identified cutoffs were lower than those previously reported and yielded more false positives and lower specificity.
Conclusions: Clinicians can use the HDRS and all forms of the BDI to screen for MD in women early after CABG, but instruments with only cognitive symptoms yield more false positives. For the HDRS and BDI, MD cutoffs should be adjusted upwards; for the BDI-SF and BDI-PC, MD cutoffs should be adjusted downward.