IJCS - International Journal of Cardiovascular Sciences

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Volume 31, Nº 4, July and August 2018


DOI: http://www.dx.doi.org/10.5935/2359-4802.20180037


Methods of Screening for Depression in Outpatients with Heart Failure

Thaís de Rezende Bessa Guerra

Isabella Cristina Diniz Venancio

Daniel Mählmann de Moura Pinheiro

Mauro Vitor Mendlowicz

Ana Carla Dantas Cavalcanti

Evandro Tinoco Mesquita


Background: Depression is a syndromic clinical condition underdiagnosed in patients with heart failure. Several instruments are currently applied to screen for depression.

Objective: To determine the prevalence of depression and the agreement among screening methods for depression in patients with heart failure.

Methods: Cross-sectional study conducted between March 2015 and January 2017 including 76 outpatients following up at a clinic specialized in heart failure. Depression was screened with the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), and Patient Health Questionnaire-9 (PHQ-9). The agrément among the three instruments was analyzed with Fleiss’ kappa coefficient (kF), Krippendorff’s alpha coefficient (Ck) and Cronbach’s alpha coefficient. The accuracy, sensitivity, and specificity, as well as false-positive and false-negative results of the HAM-D and PHQ-9 were calculated considering the BDI-II as the gold-standard instrument in the diagnosis of depression.

Results: The prevalence rates of depression were 72.4% (n = 55) with the HAM-D, 67.1% (n = 51) with the BDI-II, and 40.8% (n = 31) with the PHQ-9 scales. The prevalence of depression simultaneously identified by all three instruments was 28.9% (n = 22) and the diagnostic agreement (presence or absence of depression) was 47.4% (n = 36). The analysis revealed a superficial agreement (kF = Ck = 0.27) and moderate consistency ((↓C = 0.602, significantly not null, p = 0.000). Sociodemographic and clinical variables were not risk factors for depression in the evaluated sample.

Conclusion: The screening methods analyzed showed agreement and were useful in detecting depression among outpatients with heart failure. (Int J Cardiovasc Sci. 2018;31(4)414-421)

Keywords: Heart Failure; Depression / diagnosis; Depression / prevalence; Medical Records; Surveys and Questionnaires; Cross-Sectional Studies.