Quality of Life Research

, Volume 19, Issue 8, pp 1105–1113 | Cite as

Using the Short Form-36 mental summary score as an indicator of depressive symptoms in patients with coronary heart disease

  • Rosanna TavellaEmail author
  • Tracy Air
  • Graeme Tucker
  • Robert Adams
  • John F. Beltrame
  • Geoffrey Schrader



Depression is common in patients with cardiac disease; however, the use of depression-specific health instruments is limited by their increased responder and analyst burden. The study aimed to define a threshold value on the Short Form-36 (SF-36) mental component summary score (MCS) that identified depressed cardiac patients as measured by the Centre for Epidemiologic Studies Depression Scale (CES-D).


An optimal threshold was determined using receiver-operating characteristic (ROC) curves on SF-36 and CES-D data from a large cardiac cohort (N = 1,221). The performance of this threshold was evaluated in a further two cardiac populations.


In the index cohort, an SF-36 MCS score of ≤45 was revealed as an optimal threshold according to maximal Youden Index, with high sensitivity (77%, 95% CI = 74–80%) and specificity (73%, 95% CI = 69–77%). At this threshold, in a second sample of hospital cardiac patients, sensitivity was 93% (95% CI = 76–99%) and specificity was 64% (95% CI = 49–77%). In a final sample generated from a community population, specificity was 100% (95% CI = 85–100%) and sensitivity was 68% (95% CI = 61–74%) at the cut-off of 45.


The SF-36 MCS may be a useful research tool to aid in the classification of cardiac patients according to the presence or absence of depressive symptoms.


Coronary heart disease Short-Form 36 mental summary score Centre for Epidemiologic Studies Depression Scale Depression Optimal threshold 



Area under the curve


Coronary artery bypass grafting


Coronary artery disease


Centre for Epidemiologic Studies Depression Scale


Coronary heart disease


Diabetes mellitus


Health-related quality of life


Hypertension and/or high cholesterol


Identifying depression as a comorbid condition


Negative predictive value


North West Adelaide Health Service


Percutaneous coronary intervention


Positive predictive value


Receiver-operating characteristic


Short-Form 36


Short-Form 36 mental summary score


Short-Form 36 physical summary score


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Rosanna Tavella
    • 1
    Email author
  • Tracy Air
    • 2
  • Graeme Tucker
    • 4
  • Robert Adams
    • 3
  • John F. Beltrame
    • 1
  • Geoffrey Schrader
    • 2
  1. 1.Cardiology Research Unit, The Queen Elizabeth HospitalUniversity of AdelaideAdelaideAustralia
  2. 2.Discipline of PsychiatryUniversity of AdelaideAdelaideAustralia
  3. 3.Discipline of MedicineUniversity of AdelaideAdelaideAustralia
  4. 4.Health Statistics UnitDepartment of HealthAdelaideAustralia

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