Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CES-D:

Centre for Epidemiologic Studies Depression Scale

CHD:

Coronary heart disease

DM:

Diabetes mellitus

HRQoL:

Health-related quality of life

HT/Chol:

Hypertension and/or high cholesterol

IDACC:

Identifying depression as a comorbid condition

NPV:

Negative predictive value

NWAHS:

North West Adelaide Health Service

PCI:

Percutaneous coronary intervention

PPV:

Positive predictive value

ROC:

Receiver-operating characteristic

SF-36:

Short-Form 36

SF-36 MCS:

Short-Form 36 mental summary score

SF-36 PCS:

Short-Form 36 physical summary score

References

  1. Penninx, B. W., et al. (2001). Depression and cardiac mortality: Results from a community-based longitudinal study. Archives of General Psychiatry, 58(3), 221–227.

    Article  CAS  PubMed  Google Scholar 

  2. Wulsin, L. R., & Singal, B. M. (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine, 65(2), 201–210.

    Article  PubMed  Google Scholar 

  3. Glassman, A. H., et al. (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 288(6), 701–709.

    Article  CAS  PubMed  Google Scholar 

  4. Berkman, L. F., et al. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA, 289(23), 3106–3116.

    Article  PubMed  Google Scholar 

  5. Schrader, G., et al. (2005). Effect of psychiatry liaison with general practitioners on depression severity in recently hospitalised cardiac patients: A randomised controlled trial. Medical Journal of Australia, 182(6), 272–276.

    PubMed  Google Scholar 

  6. McDowell, I., & Newell, C. (1996). Measuring health: A guide to rating scales and questionnaires (p. 523). New York: Oxford University Press.

    Google Scholar 

  7. Kavan, M. G., et al. (1990). Screening for depression: Use of patient questionnaires. American Family Physician, 41(3), 897–904.

    CAS  PubMed  Google Scholar 

  8. Attkisson, C. C., & Zich, J. M. (1990). Depression in primary care. National institute of mental health (U.S.), University of California San Francisco. New York: Routledge.

    Google Scholar 

  9. Weissman, M. M., et al. (1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106(3), 203–214.

    CAS  PubMed  Google Scholar 

  10. Roberts, R. E., & Vernon, S. W. (1983). The center for epidemiologic studies depression scale: Its use in a community sample. American Journal of Psychiatry, 140(1), 41–46.

    CAS  PubMed  Google Scholar 

  11. Schulberg, H. C., et al. (1985). Assessing depression in primary medical and psychiatric practices. Archives of General Psychiatry, 42(12), 1164–1170.

    CAS  PubMed  Google Scholar 

  12. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  13. Spertus, J. A., et al. (2002). Health status predicts long-term outcome in outpatients with coronary disease. Circulation, 106(1), 43–49.

    Article  PubMed  Google Scholar 

  14. Dougherty, C. M., et al. (1998). Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III. Journal of Clinical Epidemiology, 51(7), 569–575.

    Article  CAS  PubMed  Google Scholar 

  15. Smith, H. J., Taylor, R., & Mitchell, A. (2000). A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL. Heart, 84(4), 390–394.

    Article  CAS  PubMed  Google Scholar 

  16. Ware, J. E., Jr., Kosinski, M., & Keller, S. D. (1994). SF-36 Physical, mental health summary scales: A user’s manual. Boston, Massachusettsd: The Health Institute, New England Medical Center.

    Google Scholar 

  17. Ware, J. E., Jr., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51(11), 903–912.

    Article  PubMed  Google Scholar 

  18. McCallum, J. (1995). The SF-36 in an Australian sample: Validating a new, generic health status measure. Australian Journal of Public Health, 19(2), 160–166.

    Article  CAS  PubMed  Google Scholar 

  19. Failde, I., & Ramos, I. (2000). Validity and reliability of the SF-36 Health Survey Questionnaire in patients with coronary artery disease. Journal of Clinical Epidemiology, 53(4), 359–365.

    Article  CAS  PubMed  Google Scholar 

  20. Permanyer-Miralda, G., et al. (1991). Comparison of perceived health status and conventional functional evaluation in stable patients with coronary artery disease. Journal of Clinical Epidemiology, 44(8), 779–786.

    Article  CAS  PubMed  Google Scholar 

  21. Berwick, D. M., et al. (1991). Performance of a five-item mental health screening test. Medical Care, 29(2), 169–176.

    Article  CAS  PubMed  Google Scholar 

  22. Failde, I., Ramos, I., & Fernandez-Palacin, F. (2000). Comparison between the GHQ-28 and SF-36 (MH 1–5) for the assessment of the mental health in patients with ischaemic heart disease. European Journal of Epidemiology, 16(4), 311–316.

    Article  CAS  PubMed  Google Scholar 

  23. McHorney, C. A., Ware, J. E., Jr., & Raczek, A. E. (1993). The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247–263.

    Article  CAS  PubMed  Google Scholar 

  24. Ware, J. E., Jr., et al. (1995). Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the Medical Outcomes Study. Medical Care, 33(4 Suppl), AS264–AS279.

    PubMed  Google Scholar 

  25. Wells, K. B., et al. (1989). The functioning and well-being of depressed patients. Results from the medical outcomes study. JAMA, 262(7), 914–919.

    Article  CAS  PubMed  Google Scholar 

  26. Mancuso, C. A., Peterson, M. G., & Charlson, M. E. (2000). Effects of depressive symptoms on health-related quality of life in asthma patients. Journal of General Internal Medicine, 15(5), 301–310.

    Article  CAS  PubMed  Google Scholar 

  27. Elliott, T. E., Renier, C. M., & Palcher, J. A. (2003). Chronic pain, depression, and quality of life: Correlations and predictive value of the SF-36. Pain Medicine, 4(4), 331–339.

    Article  PubMed  Google Scholar 

  28. Cheok, F., et al. (2003). Identification, course, and treatment of depression after admission for a cardiac condition: Rationale and patient characteristics for the Identifying Depression As a Comorbid Condition (IDACC) project. American Heart Journal, 146(6), 978–984.

    Article  PubMed  Google Scholar 

  29. Grant, J. F., et al. (2006) The North West Adelaide Health study: Detailed methods and baseline segmentation of a cohort for selected chronic diseases. Epidemiologic Perspectives Innovations 3(4).

  30. Grant, J.F., et al. (2008). Cohort profile: The North West Adelaide Health study (NWAHS). International Journal of Epidemiology.

  31. Bergmann, M. M., et al. (1998). Validity of self-reported diagnoses leading to hospitalization: A comparison of self-reports with hospital records in a prospective study of American adults. American Journal of Epidemiology, 147(10), 969–977.

    CAS  PubMed  Google Scholar 

  32. Heckbert, S. R., et al. (2004). Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women’s Health Initiative. American Journal of Epidemiology, 160(12), 1152–1158.

    PubMed  Google Scholar 

  33. Okura, Y., et al. (2004). Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. Journal of Clinical Epidemiology, 57(10), 1096–1103.

    Article  PubMed  Google Scholar 

  34. Ensel, W. (1986) Measuring depression: The CESD scale, in social support, life events and depression. In Lin, N., Dean, A., Ensel, W. M. (Eds.). Academic Press: New York.

  35. Zich, J. M., Attkisson, C. C., & Greenfield, T. K. (1990). Screening for depression in primary care clinics: The CES-D and the BDI. International Journal of Psychiatry in Medicine, 20(3), 259–277.

    Article  CAS  PubMed  Google Scholar 

  36. ABS. (2003). Socio-Economic Indexes for Areas, Australia, 2001. Canberra: Australian Bureau of Statistics.

    Google Scholar 

  37. Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32–35.

    Article  CAS  PubMed  Google Scholar 

  38. Walsh, T. L., et al. (2006). Screening for depressive symptoms in patients with chronic spinal pain using the SF-36 Health Survey. Spine J, 6(3), 316–320.

    Article  PubMed  Google Scholar 

  39. Schatzkin, A., et al. (1987). Comparing new and old screening tests when a reference procedure cannot be performed on all screenees. Example of automated cytometry for early detection of cervical cancer. American Journal of Epidemiology, 125(4), 672–678.

    CAS  PubMed  Google Scholar 

  40. Fluss, R., Faraggi, D., & Reiser, B. (2005). Estimation of the Youden index and its associate cutoff point. Biometric Journal, 47(4), 458–472.

    Article  Google Scholar 

  41. Schisterman, E. F., et al. (2001). TBARS and cardiovascular disease in a population-based sample. Journal of Cardiovascular Risk, 8(4), 219–225.

    Article  CAS  PubMed  Google Scholar 

  42. Stafford, L., Berk, M., & Jackson, H. J. (2007). Validity of the hospital anxiety and depression scale and patient health questionnaire-9 to screen for depression in patients with coronary artery disease. General Hospital Psychiatry, 29(5), 417–424.

    Article  PubMed  Google Scholar 

  43. Strik, J. J., et al. (2001). Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. Psychosomatics, 42(5), 423–428.

    Article  CAS  PubMed  Google Scholar 

  44. Lowe, B., et al. (2004). Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders, 81(1), 61–66.

    Article  PubMed  Google Scholar 

  45. Oliver, J., & Simmons, M. (1984). Depression as measured by the DSM-III and the beck depression inventory in an unselected adult population. Journal of Consulting and Clinical Psychology, 52(5), 892–898.

    Article  CAS  PubMed  Google Scholar 

  46. Parikh, R. M., et al. (1988). The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression. International Journal of Psychiatry in Medicine, 18(2), 169–181.

    Article  CAS  PubMed  Google Scholar 

  47. Gerety, M. B., et al. (1994). Performance of case-finding tools for depression in the nursing home: Influence of clinical and functional characteristics and selection of optimal threshold scores. Journal of the American Geriatrics Society, 42(10), 1103–1109.

    CAS  PubMed  Google Scholar 

  48. Okimoto, J. T., et al. (1982). Screening for depression in geriatric medical patients. American Journal of Psychiatry, 139(6), 799–802.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Research Unit, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Rd, Woodville South, 5011, Adelaide, SA, Australia

    Rosanna Tavella & John F. Beltrame

  2. Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia

    Tracy Air & Geoffrey Schrader

  3. Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia

    Robert Adams

  4. Health Statistics Unit, Department of Health, Adelaide, SA, Australia

    Graeme Tucker

Authors
  1. Rosanna Tavella
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tracy Air
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Graeme Tucker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John F. Beltrame
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Geoffrey Schrader
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosanna Tavella.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tavella, R., Air, T., Tucker, G. et al. Using the Short Form-36 mental summary score as an indicator of depressive symptoms in patients with coronary heart disease. Qual Life Res 19, 1105–1113 (2010). https://doi.org/10.1007/s11136-010-9671-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-010-9671-z

Keywords

Search

Navigation