Rapid screening for major depression in post-myocardial infarction patients : an investigation using Beck Depression Inventory II items

Objective: To determine the ability of three questions from the Beck Depression Inventory II (BDI-II) to detect major depressive disorder (MDD) in a cohort of patients hospitalised for acute myocardial infarction (Ml). Design: Prospective observational study. Setting: Coronary care unit and cardiac step-down unit of an urban academic medical centre. Patients: 131 post-MI patients within 72 h of symptom onset. Interventions: Patients were administered the BDI-II and participated in a structured diagnostic interview for MDD. Three individual BDI-II items (regarding sadness, loss of interest and loss of pleasure) were examined individually and in two-question combinations to determine their ability to screen for MDD. Main outcome measures: Sensitivity, specificity, negative and positive predictive values and proportion of patients with MDD correctly identified. Results: The individual items and two-question combinations had good sensitivity (76-94%), specificity (70-88%) and negative predictive values (97-99%). Item 1 (sadness) performed the best of the individual items (48% with a positive response to the item had MDD; 3% with a negative response had MDD; over 80% of patients with MDD were correctly identified). A combination of questions about sadness and loss of interest performed best among the two-question combinations (37% with positive response had MDD v 1 % with a negative response; 94% of patients with MDD were identified). Conclusions: One to two questions regarding sadness and loss of interest serve as simple and effective screening tools for post-MI depression.