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

Ann Intern Med. 2017 Nov 21;167(10):725-735. doi: 10.7326/M17-1811. Epub 2017 Nov 14.


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 produces 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.

Primary funding source: Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acute Coronary Syndrome / psychology*
  • Antidepressive Agents / therapeutic use
  • Cognitive Behavioral Therapy
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / therapy*
  • Humans
  • Psychological Tests*
  • Risk Factors


  • Antidepressive Agents