Commentary on King KM, Colella TJF, Faris P & Thompson DR (2009) Using the cardiac depression scale in men recovering from coronary artery bypass surgery. Journal of Clinical Nursing 18, 1617–1624

Abstract

Patients with coronary heart disease (CHD) who require coronary artery bypass graft (CABG) surgery are usually older and are more likely to have multiple comorbidities compared with those undergoing percutaneous coronary interventions (Niles et al. 2001). In addition to this increase in disease burden, the prevalence of depressive symptomatology among patients after CABG surgery has also been shown to be as high as 23% (Pirraglia et al. 1999). Depression and depressive symptoms are prevalent in people with CHD and are associated with adverse cardiovascular outcomes (Whooley et al. 2008). There is strong evidence that the detection and treatment of depression improves health outcomes (Somberg & Arora 2008), thus underscoring the importance of screening for depression in the cardiac care setting. As King et al. (2009) correctly highlight, the detection of even mild depression in patients following CABG surgery is important, and the cardiac depression scale (CDS), designed specifically to identify depression in patients with cardiac disease, has been shown to be sensitive in detecting a broad spectrum of depressive symptoms in patients with cardiac disease (Hare & Davis 1996). Although disease-specific health-related quality of life measures is expected to be more responsive to changes in clinical status (Sullivan et al. 2004), whether this is the case for the CDS in assessing depression in patients following CABG surgery is still to be determined. Most patients surveyed in this study by King et al. (2009) reported low scores on the Beck depression inventory (BDI) at all four points in time (mean : 4AE31–8AE08 from a possible range of 0–63), reducing the possibility of capturing any change in depression scores using the BDI is reduced. Despite the low BDI scores, it is surprising that both the BDI and the CDS had similar power in detecting change in depression scores over time. Although the focus of this article by King et al. was an examination of the utility and a validity of the CDS in patients following their first CABG surgery, further clarification about the study context and method was warranted. First, the study sample only included men. Although the authors explained that this was a sub-study of a clinical trial, no explanation was given as to why no women were included. Second, it would be useful for the readers to know why the authors selected a standardised health record audit as well as telephone contact as their method of data collection. One wonders why a self-administered questionnaire was not used, perhaps because of the written English language literacy of the study sample? Third, the authors made a perfunctory mention of the measurement of interrater reliability scores over the course of the study. The specifics of measurement were not stated. Was it only the standardised depression measures used in this study, or was it all data collected via telephone contact, and did they include data collected via the standardised health record audit? Further clarification of these interrater reliability measurements would have been worthwhile for the reader. Nevertheless, King et al. should be commended for assessing depression in their study sample using both the BDI and the CDS at four points in time over the 36-week study period;