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Screening for depression after cardiac events using the Beck Depression Inventory-II and the Geriatric Depression Scale

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Abstract

Despite findings that depression is a risk factor for heart disease and for death following cardiac events and that depressed cardiac patients experience significantly reduced quality of life and are less likely to follow treatment regimens, depression is neither adequately identified nor treated in cardiac patients. Recent calls in the literature for the use of standardized screening measures and sensitivity/specificity studies to identify useful measures compelled us to examine the sensitivity and specificity of the Beck Depression Inventory-II (BDI-II) and Geriatric Depression Scale (GDS) and recommend appropriate cut-scores for identifying depression in post-myocardial infarction or unstable angina patients. A total of 119 patients who met criteria for either acute myocardial infarction or unstable angina pectoris were recruited from coronary care units at three hospitals and interviewed in their homes approximately 2 weeks post-admission. The criterion used in the study was the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/NP). Administration of the SCID-I/NP, BDI-II, and GDS was counterbalanced using a digram-balanced approach and blinded comparison was used. Alphas were .89 for BDI-II and .88 for GDS. For major depression, a BDI-II cut-score of 10 produced a sensitivity = 100%, specificity = 75%, and PPV = 18% whereas a GDS cut-score of 14 produced sensitivity = 100%, specificity = 94%, and PPV = 50%. For major/double depression, a BDI-II cut-score of 10 produced sensitivity = 100%, specificity = 75%, and PPV = 21% whereas a GDS cut-score of 13 produced sensitivity = 100%, specificity = 91%, and PPV = 41%. Although both measures demonstrated excellent reliability and sensitivity, the GDS showed better specificity and PPV and is recommended as the better screen for major depression or double depression with cardiac patients.

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Acknowledgments

Both authors have had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We express our gratitude to the clinical nurse leaders, patient service coordinators, staff nurses, and unit clerks at the coronary care units of St. Paul’s Hospital, Vancouver General Hospital, and Surrey Memorial Hospital. In particular, we would like to thank Dr. Karin Humphries, Martha Mackay, Bonnie Cart, Gayle Boddie, and Denise Kinch. We also thank Lara Russell for her technical assistance and our research assistants, Anne Lee, Priscilla Ang, Sarah Chan, Cindy Chow, Kim Boivin, Victoria Brown, Kristine Hagen, Hiroe Li, Golnaz Pouriankier, and Kenda Sewell, for their assistance in implementing this project. Parts of this article were presented at the Canadian Cardiovascular Congress, Montreal, PQ, Canada, October 24, 2005 and the 113th Annual Convention of the American Psychological Association, Washington, DC, August 18, 2005.

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  1. Adult Development and Psychometrics Lab, Department of ECPS, University of British Columbia, 2125 Main Mall, Vancouver, BC, Canada, V6T 1Z4

    Gail D. Low & Anita M. Hubley

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  1. Gail D. Low
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  2. Anita M. Hubley
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Correspondence to Anita M. Hubley.

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Low, G.D., Hubley, A.M. Screening for depression after cardiac events using the Beck Depression Inventory-II and the Geriatric Depression Scale. Soc Indic Res 82, 527–543 (2007). https://doi.org/10.1007/s11205-006-9049-3

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