Thaís de Rezende Bessa Guerra et al. Isabella Cristina Diniz Venancio Daniel Mählmann de Moura Pinheiro Mauro Vitor Mendlowicz … Ana Carla Dantas Cavalcanti Evandro Tinoco Mesquita
Abstract
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 agreement 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.