Diagnostic accuracy of scales for depression screening in patients with heart failure: systematic review and meta-analysis

Abstract

Introduction: despite the existence of recommendations for the screening depressive symptoms in patients with cardiovascular disease and heart failure (HF), there are no comparative data regarding the performance of psychometric scales used in patients with HF. This study compares the psychometric performance of screening scales used for depressive symptoms in such patients. Methods: PRISMA declaration recommendations were used for the systematic review. MEDLINE, EMBASE, Psychology and Behavioral Sciences Collection, SCOPUS, Lilacs, Australasian Medical Index and the African Index from January 2000 to February 2016 were used for the search. The eligible articles were published in any language and they assessed the psychometric properties of screening scales for depressive symptoms in patients with HF. QUADAS-2 criteria was used for quality assessment, and a meta-analysis developed through a hierarchical model obtained the cluster estimations for sensitivity, specificity, likelihood ratio, predictive values, and diagnostic odds ratio (DOR) with 95% confidence intervals. Results: the initial search identified 1238 citations; only three gathered the inclusion criteria for quantitative assessment. The combined sensitivity and specificity was 56% (95% IC: 45-67%; T2=0.05) and 98% (95% IC: 96-99%; T2=0.01) respectively. The area under the curve was 0.92 (95% IC: 0.90-0.94). The variables related with the index test, reference test, Global QUDAS-2 score, and language predicted heterogeneity. Limitations: significant heterogeneity, small number of studies, selective cutoff report, and the lack of a cost-effectiveness analysis. Conclusions: The GDS-15, HADS-D, PHQ-9, CAT-D and PROMIS scales performed similarly with high specificity values.