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Rapid screening for major depression in post-myocardial infarction patients: an investigation using Beck Depression Inventory II items
  1. J C Huffman1,*,
  2. F A Smith1,*,
  3. M A Blais1,*,
  4. M E Beiser3,
  5. J L Januzzi2,*,
  6. G L Fricchione1,*
  1. 1Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3School of Nursing, Columbia University, New York, New York, USA
  1. Correspondence to:
    Dr Jeff C Huffman
    Massachusetts General Hospital, 55 Fruit Street, Warren 1220 C, MA 02114, USA; jhuffman{at}


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 (MI).

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.

  • BDI-II, Beck Depression Inventory II
  • DSM-IV, Diagnostic and statistical manual of mental disorders, 4th ed
  • ENRICHD, Enhancing Recovery in Coronary Heart Disease Patients
  • MDD, major depressive disorder
  • MI, myocardial infarction
  • SADHART, Sertraline Antidepressant Heart Attack Randomized Trial
  • SCID, Structured clinical interview for DSM-IV Axis I disorders

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  • * Also Harvard Medical School, Boston, Massachusetts, USA

  • Published Online First 27 April 2006

  • Competing interests: None declared.