• Jason A Nieuwsma, John W Williams, Natasha Namdari, Jeffrey B Washam, Giselle Raitz, James A Blumenthal, Wei Jiang, Roshini Yapa, Amanda J McBroom, Kathryn Lallinger, Robyn Schmidt, Andrzej S Kosinski, and Gillian D Sanders.
• From Duke University School of Medicine, Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Evidence Synthesis Center, Durham, North Carolina, and Southern California Permanente Medical Group, Anaheim, California; and University of Washington, Boise, Idaho.
• Ann. Intern. Med. 2017 Nov 21; 167 (10): 725-735.

BackgroundPatients who have had an acute coronary syndrome (ACS) event have an increased risk for depression.PurposeTo evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event.Data SourcesMEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles.Study SelectionEnglish-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments.Data Extraction2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence.Data SynthesisEvidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care.LimitationFew studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest.ConclusionDepression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes.Primary Funding SourceAgency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

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