Skip to main content
Log in

Optimizing Detection of Major Depression Among Patients with Coronary Artery Disease Using the Patient Health Questionnaire: Data from the Heart and Soul Study

  • Brief Report
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Clinical guidelines recommend depression screening in patients with coronary artery disease (CAD), but how to accomplish this is unclear.

OBJECTIVE

We evaluated the test characteristics of the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), and a two-step screening approach (PHQ-2 then PHQ-9 if positive on PHQ-2), compared with the Computerized Diagnostic Interview Schedule (C-DIS) for major depression. We also evaluated a “PHQ diagnosis” of depression, requiring five of nine symptoms “more than half the days,” compared with the C-DIS.

DESIGN

Cross-sectional study of 1,024 outpatients with CAD.

MAIN RESULTS

Two hundred twenty-four patients (22%) had current major depression. Optimal cutpoints were ≥2 for the PHQ-2 (82% sensitive, 79% specific) and ≥6 for the PHQ-9 (83% sensitive, 76% specific). The two-step screening approach was less sensitive (75%), but more specific (84%), than the PHQ-2 or PHQ-9 alone. The “PHQ diagnosis” had low sensitivity (28%), but high specificity (96%).

CONCLUSIONS

Cutpoints of ≥2 on the PHQ-2 and ≥6 on the PHQ-9 had similar test characteristics. A two-step approach using the PHQ-2 followed by the PHQ-9 was no better than either instrument alone. A “PHQ diagnosis” of depression had high specificity, but poor sensitivity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

References

  1. Thombs BD, Bass EB, Ford DE, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21:30–38.

    Article  PubMed  Google Scholar 

  2. Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatry. 2003;54:227–40.

    Article  PubMed  Google Scholar 

  3. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol. 2004;44:E1–E211.

    Article  PubMed  Google Scholar 

  4. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol. 2007;50:e1–e157.

    Article  PubMed  Google Scholar 

  5. Mosca L, Banka CL, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. J Am Coll Cardiol. 2007;49:1230–50.

    Article  PubMed  Google Scholar 

  6. Davidson KW, Kupfer DJ, Bigger JT, et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group report. Psychosom Med. 2006;68:645–50.

    Article  PubMed  CAS  Google Scholar 

  7. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med Care. 2003;41:1284–92.

    Article  PubMed  Google Scholar 

  8. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

    Article  PubMed  CAS  Google Scholar 

  9. Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC. Diagnostic accuracy of the mood module of the Patient Health Questionnaire: A systematic review. Gen Hosp Psychiatry. 2007;29:388–95.

    Article  PubMed  Google Scholar 

  10. Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): A diagnostic meta-analysis. J Gen Intern Med. 2007;22:1596–1602.

    Article  PubMed  Google Scholar 

  11. McManus D, Pipkin SS, Whooley MA. Screening for depression in patients with coronary heart disease (data from the Heart and Soul Study). Am J Cardiol. 2005;96:1076–81.

    Article  PubMed  Google Scholar 

  12. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–9.

    PubMed  CAS  Google Scholar 

  13. Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29:417–24.

    Article  PubMed  Google Scholar 

  14. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–44.

    Article  PubMed  CAS  Google Scholar 

  15. Blouin AG, Perez EL, Blouin JH. Computerized administration of the Diagnostic Interview Schedule. Psychiatry Res. 1988;23:335–44.

    Article  PubMed  CAS  Google Scholar 

  16. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.

    PubMed  CAS  Google Scholar 

  17. U.S. Preventive Services Task Force. Screening for depression: Recommendations and rationale. Ann Intern Med. 2002;136:760–64.

    Google Scholar 

  18. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27:2763–74.

    Article  PubMed  Google Scholar 

  19. Friedman GD, Cutter GR, Donahue RP, et al. CARDIA: Study design, recruitment and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41:1105–16.

    Article  PubMed  CAS  Google Scholar 

  20. Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991;1:263–76.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The Heart and Soul Study was funded by the Department of Veterans Epidemiology Merit Review Program, the Department of Veterans Affairs Health Services Research and Development service, the National Heart Lung and Blood Institute (R01 HL079235), the American Federation for Aging Research (Paul Beeson Scholars Program), the Robert Wood Johnson Foundation (Generalist Physician Faculty Scholars Program), and the Ischemia Research and Education Foundation. Dr. Thombs is supported by a New Investigator Award from the Canadian Institutes of Health Research and an Établissement de Jeunes Chercheurs award from the Fonds de la Recherche en Santé Québec. Dr. Ziegelstein is supported by grant no. R24AT004641 from the National Center For Complementary and Alternative Medicine and by the Miller Family Scholar Program.

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brett D. Thombs PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thombs, B.D., Ziegelstein, R.C. & Whooley, M.A. Optimizing Detection of Major Depression Among Patients with Coronary Artery Disease Using the Patient Health Questionnaire: Data from the Heart and Soul Study. J GEN INTERN MED 23, 2014–2017 (2008). https://doi.org/10.1007/s11606-008-0802-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0802-y

KEY WORDS

Navigation