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Depression screening: utility of the patient health questionnaire in patients with acute coronary syndrome

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McGuire AW, Eastwood JA, Macabasco-O’Connell A, Hays RD, Doering LV.
American Journal of Critical Care, January 2013



Depression screening in cardiac patients has been recommended by the American Heart Association, but the best approach remains unclear.


To evaluate nurse-administered versions of the Patient Health Questionnaire for depression screening in patients hospitalized for acute coronary syndrome.


Staff nurses in an urban cardiac care unit administered versions 2, 9, and 10 of the questionnaire to 100 patients with acute coronary syndrome. The Depression Interview and Structured Hamilton was administered by advanced practice nurses blinded to the results of the Patient Health Questionnaire. With the results of the Depression Interview and Structured Hamilton as a criterion, receiver operating characteristic analyses were done for each version of the Patient Health Questionnaire. The Delong method was used for pairwise comparisons. Cutoff scores balancing false-negatives and false-positives were determined by using the Youden Index.


Each version of the questionnaire had excellent area-under- the-curve statistics: 91.2%, 92.6%, and 93.4% for versions 2, 9, and 10, respectively. Differences among the 3 versions were not significant. Each version yielded higher symptom scores in depressed patients than in nondepressed patients: version 2 scores, 3.4 vs 0.6, P = .001; version 9 scores, 13 vs 3.4, P < .001; and version 10 scores, 14.5 vs 3.6, P < .001.


For depression screening in hospitalized patients with acute coronary syndrome, the Patient Health Questionnaire 2 is as accurate as longer versions when administered by nurses. Further study is needed to determine if screening with this tool changes clinical decision making or improves outcomes in these patients.

Copyright © 2013 by the American Association of Critical-Care Nurses

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Additional Information

Our research was done in response to the scientific advisory from the American Heart Association Prevention Committee of the Council  on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes research: Endorsed by the American Psychiatric Association in 2008:  “Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment”  Published in the Circulation journal in 2008. The recommendation left questions related to whom, how, when, and where to accomplish the important goal of increasing general health improvement outcomes by identify depression in coronary heart disease patients.  Our research demonstrates the ability of bedside nurses to accurately and reliably use the brief Patient Health Questionnaire (PHQ-2) as a depression screening tool in hospitalized patients.   This method provides one option to increasing depression case finding in coronary heart patients.  Barriers remain in the screening, referral, and treatment of depression in the coronary heart disease population.  I plan on continuing to research this area and would welcome collaboration from any discipline.

Depression screening utility of the patient health questionnaire in patients with acute coronary syndrome

Anthony McGuire, PhD, RN, ACNP-BC, CCRN