Diagnostic Accuracy of Screening Tests and Treatment for Post-Acute Coronary Syndrome Depression A Systematic Review

作者：Nieuwsma Jason A^*; Williams John W Jr; Namdari Natasha; Washam Jeffrey B; Raitz Giselle; Blumenthal James A; Jiang Wei; Yapa Roshini; McBroom Amanda J; Lallinger Kathryn; Schmidt Robyn; Kosinski Andrzej S; Sanders Gillian D

来源：Annals of Internal Medicine, 2017, 167(10): 725-+.

DOI：10.7326/M17-1811

Background: Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression.
Purpose: To 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 Sources: MEDLINE, 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 Selection: English-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 Extraction: 2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence.
Data Synthesis: Evidence from 6 of the 10 included studies showed that a range of depression screening instruments pro-duces 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.
Limitation: Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest.
Conclusion: Depression 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.

• 出版日期2017-11-21