Download PDF
Psychiatr Prax 2019; 46(01): 41-48
DOI: 10.1055/s-0042-123434
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Erkennungsgüte dreier deutschsprachiger Screeninginstrumente für Depression bei hospitalisierten Patienten mit koronarer Herzerkrankung

Diagnostic Accuracy of German Depression Screenings in Patients with Coronary Heart Disease
Mira Tschorn   *
1   Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin
2   Sozial- und Präventivmedizin, Strukturbereich Kognitionswissenschaften, Department Sport- und Gesundheitswissenschaften, Universität Potsdam
,
Nina Rieckmann   *
3   Institut für Public Health, Charité – Universitätsmedizin Berlin
,
Volker Arolt
4   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster
,
Katja Beer
1   Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin
,
Wilhelm Haverkamp
5   Medizinische Klinik mit Schwerpunkt Kardiologie, Charité – Universitätsmedizin Berlin
,
Peter Martus
6   Institut für Klinische Epidemiologie und angewandte Biometrie, Universitätsklinikum Tübingen
,
Johannes Waltenberger
7   Department für Kardiologie und Angiologie, Universitätsklinikum Münster
,
Jacqueline Müller-Nordhorn   **
3   Institut für Public Health, Charité – Universitätsmedizin Berlin
,
Andreas Ströhle   **
1   Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
03 April 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ziel Vergleich der Erkennungsgüte von drei Depressions-Screeninginstrumenten bei Patienten mit koronarer Herzerkrankung (KHK).

Methodik 1019 KHK-Patienten erhielten den Patient Health Questionnaire (PHQ-9 und PHQ-2) und die Hospital Anxiety and Depression Scale (HADS-D) sowie ein klinisches Interview (Composite International Diagnostic Interview) als Referenzstandard.

Ergebnisse Bezüglich der Erkennungsgüte waren PHQ-9 und HADS-D dem PHQ-2 überlegen. Optimale Cut-off-Werte waren 7 (PHQ-9 und HADS-D) und 2 (PHQ-2).

Schlussfolgerung PHQ-9 und HADS-D haben eine vergleichbare Diskriminationsfähigkeit für depressive Störungen bei KHK-Patienten.

Abstract

Objective To compare the diagnostic accuracy of German depression screening instruments in patients with coronary heart disease (CHD).

Methods 1019 CHD patients completed the Patient Health Questionnaire (PHQ-9 and PHQ-2) and the Hospital Anxiety and Depression Scale (HADS-D). The Composite International Diagnostic Interview served as reference standard for “any depressive disorder” and “major depression”.

Results The accuracy of the PHQ-9 and the HADS-D was comparable according to the area under the curve, and both were superior to the PHQ-2. The optimal cut-off according to the Youden index (maximum sum of sensitivity and specificity) was 7 for both instruments. At this optimal cut-off, the PHQ-9 had a higher sensitivity compared to the HADS-D, but a lower specificity (below 68). Results remained similar when patients who reported that they currently underwent treatment for depression were excluded.

Conclusion The PHQ-9 and the HADS-D have comparable overall diagnostic accuracy in CHD patients. In line with previous screening studies with CHD patients, the optimal cut-offs were below the cut-offs that are recommended in the literature.

Schlüsselwörter

koronare Herzerkrankung - Depression - Diagnose - Screening - Validität

Keywords

coronary artery disease - depression - diagnosis - screening - validity

* geteilte Erstautorenschaft


** geteilte Seniorautorenschaft


Die Tab. 3 und 4 finden Sie online.

 

  • Literatur

  • 1 Statistisches Bundesamt. Todesursachen in Deutschland. Fachserie 12 Reihe 4 (10.04.2016). Im Internet: https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Todesursachen/Todesursachen2120400147004.pdf;jsessionid=2D418B30B657DAC0E06CB0E10A981C55.cae1?__blob=publicationFile (Stand: 10.04.2016)
    Google Scholar
  • 2 Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatry 2003; 54: 227-240
    CrossrefPubMedGoogle Scholar
  • 3 Thombs BD, Bass EB, Ford DE. et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006; 21: 30-38
    CrossrefPubMedGoogle Scholar
  • 4 Van Melle JP, De Jonge P, Spijkerman TA. et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004; 66: 814-822
    CrossrefPubMedGoogle Scholar
  • 5 Wittchen H-U, Pittrow D. Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study. Hum Psychopharmacol Clin Exp 2002; 17: S1-S11
    CrossrefPubMedGoogle Scholar
  • 6 Kohn R, Saxena S, Levav I. et al. The treatment gap in mental health care. Bull World Health Organ 2004; 82: 858-866
    PubMedGoogle Scholar
  • 7 Carney RM, Rich MW, Tevelde A. et al. Major depressive disorder in coronary artery disease. Am J Cardiol 1987; 60: 1273-1275
    CrossrefPubMedGoogle Scholar
  • 8 Ziegelstein RC, Kim SY, Kao D. et al. Can doctors and nurses recognize depression in patients hospitalized with an acute myocardial infarction in the absence of formal screening?. Psychosom Med 2005; 67: 393-397
    CrossrefPubMedGoogle Scholar
  • 9 Thombs BD, Ziegelstein RC. Depression screening in patients with coronary heart disease: Does the evidence matter?. J Psychosom Res 2013; 75: 497-499
    PubMedGoogle Scholar
  • 10 Albus C, Jordan J, Herrmann-Lingen C. Screening for psychosocial risk factors in patients with coronary heart disease-recommendations for clinical practice. Eur J Cardiovasc Prev Rehabil 2004; 11: 75-79
    CrossrefPubMedGoogle Scholar
  • 11 Ladwig K-H, Lederbogen F, Albus C. et al. Positionspapier zur Bedeutung psychosozialer Faktoren in der Kardiologie. Kardiologe 2013; 7: 7-27
    CrossrefPubMedGoogle Scholar
  • 12 Lichtman JH, Bigger JT, Blumenthal JA. et al. Depression and coronary heart disease recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 2008; 118: 1768-1775
    CrossrefPubMedGoogle Scholar
  • 13 Siu AL, Bibbins-Domingo K, Grossman DC. et al. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA 2016; 315: 380-387
    CrossrefPubMedGoogle Scholar
  • 14 Thombs BD, de Jonge P, Coyne JC. et al. Depression screening and patient outcomes in cardiovascular care: A systematic review. JAMA 2008; 300: 2161-2171
    CrossrefPubMedGoogle Scholar
  • 15 Löwe B, Spitzer RL, Zipfel S, Herzog W. Gesundheitsfragebogen für Patienten (PHQ D). Komplettversion und Kurzform. Testmappe mit Manual, Fragebögen, Schablonen. Karlsruhe: Pfizer; 2002
    Google Scholar
  • 16 Whooley MA, Avins AL, Miranda J. et al. Case-finding instruments for depression. J Gen Intern Med 1997; 12: 439-445
    CrossrefPubMedGoogle Scholar
  • 17 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
    CrossrefPubMedGoogle Scholar
  • 18 Wittchen H-U, Pfister H. DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime). Ergänzungsheft (DIA-X-12 Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets & Zeitlinger; 1997
    Google Scholar
  • 19 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med 2001; 16: 606
    CrossrefPubMedGoogle Scholar
  • 20 Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41: 1284-1292
    CrossrefPubMedGoogle Scholar
  • 21 Herrmann-Lingen CH, Buss U, Snaith RP. HADS-D: hospitality anxiety and depression scale: Deutsche Version: ein Fragebogen zur Erfassung von Angst und Depressivität in der Somatischen Medizin. Bern: Huber; 2005
    Google Scholar
  • 22 Bjelland I, Dahl AA, Haug TT. et al. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52: 69-77
    CrossrefPubMedGoogle Scholar
  • 23 Jacobi F, Mack S, Gerschler A. et al. The design and methods of the mental health module in the German Health Interview and Examination Survey for Adults (DEGS1-MH). Int J Methods Psychiatr Res 2013; 22: 83-99
    CrossrefPubMedGoogle Scholar
  • 24 Reed V, Gander F, Pfister H. et al. To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. Int J Methods Psychiatr Res 1998; 7: 142-155
    CrossrefPubMedGoogle Scholar
  • 25 Mergl R, Seidscheck I, Allgaier A-K. et al. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety 2007; 24: 185-195
    CrossrefPubMedGoogle Scholar
  • 26 Härter M, Woll S, Wunsch A. et al. Screening for mental disorders in cancer, cardiovascular and musculoskeletal diseases. Soc Psychiatry Psychiatr Epidemiol 2006; 41: 56-62
    CrossrefPubMedGoogle Scholar
  • 27 Wunsch A, Rundel M, Härter M. et al. Screening psychischer Störungen in der kardiologischen und orthopädischen Rehabilitation. Rehabil 2002; 41: 375-381
    PubMedGoogle Scholar
  • 28 Papassotiropoulos A, Heun R. Screening for depression in the elderly: a study on misclassification by screening instruments and improvement of scale performance. Prog Neuropsychopharmacol Biol Psychiatry 1999; 23: 431-446
    CrossrefPubMedGoogle Scholar
  • 29 Williams P, Goldberg DP. A user’s guide to the General Health Questionnaire. Berkshire: NFER Nelson; 1988
    Google Scholar
  • 30 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837-845
    CrossrefPubMedGoogle Scholar
  • 31 Youden WJ. Index for rating diagnostic tests. Cancer 1950; 3: 32-35
    CrossrefPubMedGoogle Scholar
  • 32 Löwe B, Spitzer RL, Gräfe K. et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 2004; 78: 131-140
    CrossrefPubMedGoogle Scholar
  • 33 Löwe B, Gräfe K, Zipfel S. et al. Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire. Psychother Psychosom 2004; 73: 386-390
    CrossrefPubMedGoogle Scholar
  • 34 Hahn D, Reuter K, Härter M. Screening for affective and anxiety disorders in medical patients-comparison of HADS, GHQ-12 and Brief-PHQ. Im Internet: GMS Psycho-Soc Med; 10.04.2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736509 (Stand: 10.04.2016)
    Google Scholar
  • 35 Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007; 29: 417-424
    CrossrefPubMedGoogle Scholar
  • 36 McManus D, Pipkin SS, Whooley MA. Screening for depression in patients with coronary heart disease (data from the Heart and Soul Study). Am J Cardiol 2005; 96: 1076-1081
    CrossrefPubMedGoogle Scholar
  • 37 Bunevicius A, Staniute M, Brozaitiene J. et al. Diagnostic accuracy of self-rating scales for screening of depression in coronary artery disease patients. J Psychosom Res 2012; 72: 22-25
    CrossrefPubMedGoogle Scholar
  • 38 Haworth JE, Moniz-Cook E, Clark AL. et al. An evaluation of two self-report screening measures for mood in an out-patient chronic heart failure population. Int J Geriatr Psychiatry 2007; 22: 1147-1153
    CrossrefPubMedGoogle Scholar
  • 39 Maske UE, Busch MA, Jacobi F. et al. Current major depressive syndrome measured with the Patient Health Questionnaire-9 (PHQ-9) and the Composite International Diagnostic Interview (CIDI): results from a cross-sectional population-based study of adults in Germany. BMC Psychiatry 2015; 15: 1
    CrossrefPubMedGoogle Scholar
  • 40 Thombs BD, Ziegelstein RC, Whooley MA. Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. J Gen Intern Med 2008; 23: 2014-2017
    CrossrefPubMedGoogle Scholar
  • 41 Gilbody S, Sheldon T, Wessely S. Health policy: Should we screen for depression?. BMJ 2006; 332: 1027
    CrossrefPubMedGoogle Scholar