Abstract 20411: Depression Screening and Case-Finding Tools in Heart Failure: Timing Matters
Depression in HF is associated with noncompliance to treatment recommendations, reduced health status and quality of life, and increased hospital readmission and mortality. Early and accurate screening and case-finding for depression in HF patient is critical. The purpose of this study was to evaluate the performance of common depression screening tools in HF patients in both acute or outpatient setting.
Methods: At hospital admission, 118 veterans (99% male, 68 ± 10 years) were evaluated for clinical depression; 96 were tested again at 6 months. At both times, 3 screening tools (Beck Depression Inventory [BCI], Patient Health Questionnaire [PHQ]-2, and PHQ-9) were completed. Clinical depression was measured by the Diagnostic Interview Structured Hamilton (DISH) administered by trained nurses. Performance of each tool was evaluated with receiver operating characteristics (ROC) analysis and calculation of sensitivity, specificity, and positive predictive value (PPV).
Results: In hospital and 6 months later as outpatients, 24 (20.3%) and 14 (14.6%) veterans exhibited clinical depression, respectively. For all 3 tools, area under the curve values were significant (Table). At hospitalization, cut-off scores above those normally suggested provided superior sensitivity, specificity and PPV. For screening with high cut-offs, the BDI and PHQ-9 yield acceptable sensitivity. For case-finding, the BDI exhibited acceptable PPV at a high cut-off. At 6 months, optimal cut-offs all 3 tools approached those normally suggested, with the PHQ-2 yielding a stronger PPV than the BDI or PHQ-9.
Conclusion: While all 3 tools were useful for depression screening and case-finding in HF, timing relative to hospital admission influences performance. While the BDI works well for screening and case-finding, the PHQ-9 performs better for screening at hospital admission and the PHQ-2 performs better for case-finding 6 months after admission.
Author Disclosures: T. Corvera-Tindel: None. L.V. Doering: None.
- © 2014 by American Heart Association, Inc.