Screening for depression after cardiac events using the Beck Depression Inventory-II and the Geriatric Depression Scale

Despite findings that depression is a risk factor for heart disease and for death following cardiac events and that depressed cardiac patients experience significantly reduced quality of life and are less likely to follow treatment regimens, depression is neither adequately identified nor treated in cardiac patients. Recent calls in the literature for the use of standardized screening measures and sensitivity/specificity studies to identify useful measures compelled us to examine the sensitivity and specificity of the Beck Depression Inventory-II (BDI-II) and Geriatric Depression Scale (GDS) and recommend appropriate cut-scores for identifying depression in post-myocardial infarction or unstable angina patients. A total of 119 patients who met criteria for either acute myocardial infarction or unstable angina pectoris were recruited from coronary care units at three hospitals and interviewed in their homes approximately 2 weeks post-admission. The criterion used in the study was the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/NP). Administration of the SCID-I/NP, BDI-II, and GDS was counterbalanced using a digram-balanced approach and blinded comparison was used. Alphas were .89 for BDI-II and .88 for GDS. For major depression, a BDI-II cut-score of 10 produced a sensitivity = 100%, specificity = 75%, and PPV = 18% whereas a GDS cut-score of 14 produced sensitivity = 100%, specificity = 94%, and PPV = 50%. For major/double depression, a BDI-II cut-score of 10 produced sensitivity = 100%, specificity = 75%, and PPV = 21% whereas a GDS cut-score of 13 produced sensitivity = 100%, specificity = 91%, and PPV = 41%. Although both measures demonstrated excellent reliability and sensitivity, the GDS showed better specificity and PPV and is recommended as the better screen for major depression or double depression with cardiac patients.