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Comment & Response
March 2020

Additional Considerations for Screening and Treatment of Depression in Patients With Acute Coronary Syndrome—Reply

Author Affiliations
  • 1Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
  • 2Department of Medicine, Northwell Health, New York, New York
JAMA Intern Med. 2020;180(3):473-474. doi:10.1001/jamainternmed.2019.7113

In Reply We thank Bush et al for their comments on the Comparison of Depression Interventions After Acute Coronary Syndrome: Quality of Life randomized clinical trial.1 We provide a response to their concern that our recommendation to reconsider depression-screening guidelines was premature. First, they note that the prevalence of depression in our sample was lower than expected. The low prevalence of screening-detected depression (7% actual vs 20% expected) contributed to our recommendation to reconsider the depression-screening guidelines. When the prevalence of depression is low, the number needed to screen to identify a single case of depression increases, which limits opportunities for depression screening to be cost-effective. Nevertheless, we agree that other approaches to depression screening could increase the detection of depression. In our trial, depression screening was performed over the telephone in the context of a research study. Although previous studies2 suggest that there are minimal differences between telephone-conducted and self-administered depression-screening instruments, other approaches or contexts for depression screening could result in higher detection rates. Additionally, to be consistent with recommended methods for universal screening, we excluded patients with current depression or a history of depression. Future depression-screening trials might expand eligibility to include patients with a history of depression, as some of these patients may benefit from increased identification of undertreated symptoms. However, recommendation statements such as those generated by the US Preventive Services Task Force do not ordinarily consider studies that include patients previously diagnosed as having a particular condition.3

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