Effects of depression screening on psychiatric outcomes in patients with acute coronary syndrome: Findings from the K-DEPACS and EsDEPACS studies. (1st July 2015)

• Record Type: Journal Article
• Authors: Kang, Hee-Ju; Stewart, Robert; Bae, Kyung-Yeol; Kim, Sung-Wan; Shin, Il-Seon; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho; Yoon, Jin-Sang; Kim, Jae-Min
• Is Part Of: International journal of cardiology. Volume 190(2015)
• Page Start: 114
• Page End: 121
• Publication Date: 2015-07-01
• Subjects: ACS acute coronary syndrome -- BDI Beck Depression Inventory -- BMI body mass index -- CK-MB creatine kinase-MB -- DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th Edition -- EKG electrocardiography -- EsDEPACS Escitalopram for DEPression in Acute Coronary Syndrome study -- HAMD Hamilton Depression Rating Scale -- K-DEPACS Korean DEPression in Acute Coronary Syndrome study -- LVEF left ventricular ejection fraction -- MI myocardial infarction -- MINI Mini International Neuropsychiatric Interview -- RCT randomized controlled trial; Depressive disorder -- Acute coronary syndrome -- Screening -- Escitalopram -- Psychiatric outcome; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.04.164
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: It has been controversial whether routine screening for depression should be recommended in all patients with acute coronary syndrome (ACS) due to lack of evidence for psychiatric as well as for cardiac outcomes. This study aimed to evaluate the result of screening for treatment and subsequent treatment of depression on one-year psychiatric outcomes in ACS. Methods: At baseline 1152 patients with recently developed ACS were screened with the Beck Depression Inventory (BDI) and depressive disorder diagnoses were applied according to DSM-IV criteria. Of the 446 patients with depressive disorder, 300 were randomized to a 24-week double-blind trial of escitalopram or placebo, while the remaining 146 received conventional medical treatment only (MTO) without randomization. Of all baseline participants, 828 were followed up one year later. Psychiatric outcomes included BDI, Hamilton Depression Rating Scale (HAMD), Montgomery Asberg Depression Rating Scale (MADRS), Social and Occupational Functioning Assessment Scale (SOFAS) and the World Health Organization Disability Assessment Schedule-12 (WHODAS-12). Results: BDI screen-positive ACS patients showed worse one-year outcomes on MADRS, SOFAS, and WHODAS scores (p-values < 0.01) compared to BDI screen-negative patients. Escitalopram treatment was associated with beneficial effects compared to placebo and MTO on one-year outcomes on HAMD, MADRS and SOFAS (p-values < 0.01). Of patients screening positive on the BDI, those with depressive disorder treated with escitalopram had similar outcomes to those without depressive disorder. Conclusions: Routine screening of depressive symptom in ACS patients is helpful to plan further management. Moreover, successive accurate diagnosis of depressive disorder with appropriated treatment is effective at least for psychiatric outcomes. Highlights: Depression screening and treatment effects on 1 year ACS outcomes were examined. Screening positive patients showed worse outcomes than screening negative ones. Escitalopram treatment for depression had beneficial effects on 1 year outcomes. Depression screening and subsequent treatment are recommended in ACS patients.