Marin 2020

S YS T E M AT I C R E V I E W
Screening for depression and anxiety among patients

with acute coronary syndrome in acute care settings:
a scoping review
Tania S. Marin 1,2 Sandra Walsh 3 Nikki May 4 Martin Jones 3 Richard Gray 5 Eimear Muir-Cochrane 1
Robyn A. Clark 1
1
College of Nursing and Health Sciences, Flinders University, Adelaide, Australia, 2JBI, Faculty of Health and Medical Sciences, The University of
Adelaide, Adelaide, Australia, 3Department of Rural Health, University of South Australia, Warnambool, Australia, 4South Australian Health Library
Service, Flinders Medical Centre, Bedford Park, Australia, and 5School of Nursing and Midwifery, LaTrobe University, Bundoora, Australia
ABSTRACT
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKbH4TTImqenVIu1/FN/J4kOZfuPAFA0w79F019oHEXuFBJYGd4dTL17EBVJgCn7YS8= on 09/21/2020
Objective: The aim of this review was to scope the literature for publications on the practice of screening for
depression and anxiety in acute coronary syndrome patients in acute care by identifying instruments for the
screening of anxiety and/or depression; determining if screening for anxiety and/or depression has been integrated
into cardiac models of care and clinical pathways; and identifying any evidence practice gap in the screening and
management of anxiety and/or depression in this population.
Introduction: Depression in acute coronary syndrome is bidirectional. Depression is an independent risk factor for
cardiovascular disease, and comorbid depression is associated with a twofold greater risk of mortality in patients with
cardiovascular disease. The presence of acute coronary syndrome increases the risk of depressive disorders or anxiety
during the first one to two years following an acute event, and both depression and anxiety are associated with a
higher risk of further acute coronary health concerns. Clinical practice guidelines have previously recommended
routine screening for depression following a cardiac event, although many current guidelines do not include
recommendations for screening in an acute setting. To date there have been no previous scoping reviews
investigating depression and anxiety screening in patients with acute coronary syndrome in the acute care setting.
Inclusion criteria: Adults (18 years and over) with acute coronary syndrome who are screened for anxiety and/or
depression (not anxiety alone) in an acute care setting.
Methods: A systematic search of the literature was conducted by a research librarian. Research studies of any design
published in English from January 1, 2012, to May 31, 2018, were included. Data were extracted from the included
studies to address the three objectives. Purposefully designed tables were used to collate information and present
findings. Data are also presented as figures and by narrative synthesis.
Results: Fifty-one articles met the inclusion criteria. Primary research studies were from 21 countries and included
21,790 participants; clinical practice guidelines were from two countries. The most common instruments used for the
screening of depression and anxiety were: i) the Hospital Anxiety and Depression Scale (n ¼ 18); ii) the Beck
Depression Inventory (n ¼ 16); and iii) the nine-item Patient Health Questionnaire (n ¼ 7). Eleven studies included
screening for anxiety in 2181 participants (30% female) using the full version of the Hospital Anxiety and Depression
Scale. The State-Trait Anxiety Inventory was used to screen 444 participants in three of the studies. Four studies
applied an intervention for those found to have depression, including two randomized controlled trials with
interventions targeting depression. Of the seven acute coronary syndrome international guidelines published since
2012, three (43%) did not contain any recommendations for screening for depression and anxiety, although four
(57%) had recommendations for treatment of comorbidities.
Conclusions: This review has identified a lack of consistency in how depression and anxiety screening tools are
integrated into cardiac models of care and clinical pathways. Guidelines for acute coronary syndrome are not consistent
in their recommendations for screening for depression and/or anxiety, or in identifying the best screening tools.
Correspondence: Tania S. Marin, tania.marin@flinders.edu.au

The authors declare no conflict of interest.
DOI: 10.11124/JBISRIR-D-19-00316
JBI Evidence Synthesis ß 2020 JBI 1932
© 2020 JBI. Unauthorized reproduction of this article is prohibited.

SYSTEMATIC REVIEW T.S. Marin et al.
Keywords acute cardiac care; acute coronary syndrome; anxiety; depression; screening
JBI Evid Synth 2020; 18(9):1932–1969.
Introduction with ACS in primary care, reinforcing that effective

epression and anxiety disorders are common depression treatment may improve health outcomes,
D comorbidities in people with acute coronary
syndrome (ACS). Acute coronary syndrome covers
and an opportunity to screen for and treat depression in
cardiac patients should not be missed.7 The same year,
the spectrum of clinical conditions ranging from the American Heart Association recommended a two-
unstable angina to non-ST-segment elevation myo- step screening method for identifying depression in
cardial infarction (NSTEMI) or ST-segment eleva- cardiovascular patients: completion of the two-item
tion myocardial infarction (STEMI), and refers to Patient Health Questionnaire (PHQ-2) followed by the
any group of clinical symptoms associated nine-item Patient Health Questionnaire (PHQ-9).11
with acute myocardial ischemia.1 Depression in Guidelines for the detection of post-MI depression also
ACS is bidirectional,2 with approximately 30% of reported that there was very strong (Level 1 Class A)
patients hospitalized for myocardial infarction (MI) evidence for these recommendations.8 However, the
experiencing depressive symptoms, 15% to 20% of mention of depression screening is absent from the
whom experience major depression as a comorbid- 2016 (and 2018) Heart Foundation of Australia and
ity.3 Depression is an independent risk factor for the Cardiac Society of Australia and New Zealand
cardiovascular disease,2,4 and comorbid depression guidelines for the treatment of ACS.12,13
is associated with a twofold greater risk of mortality There have been no previous scoping reviews on
in patients with ACS.3 Once a cardiac event has depression and anxiety screening in patients with
occurred, depression presents a higher risk of mor- ACS in the acute care setting. However, a system-
tality.5 Patients with coexisting ACS and depression atic review that evaluated the benefits of screening
may experience greater levels of disability, increased in adults in primary care settings at risk of depres-
use of healthcare services, have low compliance rates sion recommended to not routinely screen for
with medication and risk factor modification, and depression in this population.14 In the context that
higher rates of rehospitalization.2 In addition, no evidence was found for potential harms of
research has shown that people with depression screening (e.g. false-positive diagnoses with subse-
and anxiety have a significant impact on the mental quent unnecessary treatment; adverse effects of
health of their family and carers.6 medical therapy among people correctly identified
as having depression; consequences of labeling and
stigma), there is a need to identify practices in
Rationale screening for anxiety and/or depression in ACS
Clinical practice guidelines have previously recom- patients in acute coronary care.
mended routine screening for depression and anxiety A preliminary search of PROSPERO, MEDLINE,
following a cardiac event.7-9 In 2005, the American the Cochrane Database of Systematic Reviews, and
Association of Cardiovascular and Pulmonary Reha- the JBI Database of Systematic Reviews and Imple-
bilitation9 recommended screening adults for mentation Reports was conducted and no current or
depression in primary care settings, but only when in-progress scoping reviews or systematic reviews on
there are integrated staff-assisted systems available the topic were identified. Thus, the aim of this review
to manage treatment. This was followed in 2006 by was to scope the literature for publications on the
the Heart Foundation of Australia and the Cardiac practice of screening for anxiety and/or depression in
Society of Australia and New Zealand guidelines ACS patients in acute coronary care. Specifically, the
recommending that all patients with ACS be assessed objectives of this scoping review were to:
for comorbid depression.10 i) Identify instruments used in published research
In 2008, the American Heart Association and the identifying practices for the screening of anxiety
American Psychiatric Association jointly recom- and/or depression in ACS patients in the acute
mended routine screening for depression in patients care setting;

ii) Determine if screening for anxiety and/or Depression: Depression is defined as including the
depression in ACS patients has been integrated following depressive disorders from the Diagnostic
into cardiac models of care and clinical and Statistical Manual of Mental Disorders (DSM-
pathways; and 5)15: disruptive mood dysregulation disorder, major
iii) Identify if there was an evidence practice gap in depressive disorder (including major depressive epi-
the screening and management of anxiety and/or sodes), persistent depressive disorder (dysthymia),
depression in ACS patients in the acute care substance/medication-induced depressive disorder,
setting, by reviewing published clinical guidelines. depressive disorder due to another medical condi-
tion, other specified depressive disorder, and unspec-
Review question ified depressive disorder. Pre-clinical mood disorders
What is the scope of published research identifying were also included as measured by common screen-
practices in screening for anxiety and/or depression ing tools for depressive symptoms such as, but not
in ACS patients in acute coronary care? limited to, the PHQ16 and the Hospital Anxiety and
Depression Scale (HADS).17
Inclusion criteria Anxiety: Hallmarks of anxiety disorders are
Participants excessive fear and anxiety and related behavioral
This review considered studies that included partic- disturbances. Anxiety disorders differ in the type of
ipants (18 years and over) with ACS who may also objects or situations that induce fear, anxiety, or
have had procedures such as coronary artery bypass avoidance behavior, and the associated cognitive
grafting (CABG), chronic total occlusion, percuta- ideation.15 As with depression, for the purposes of
neous coronary intervention (PCI), and percutane- this scoping review we will take a broad definition of
ous transluminal coronary angioplasty (PTCA). anxiety disorders to include the symptoms measured
Acute coronary syndrome is a syndrome accompa- by common screening tools such as HADS. Only
nied by decreased blood flow in the coronary arter- when anxiety was screened along with a depressive
ies and part of the heart muscle is unable to function disorder was it included in this review. This slightly
properly or dies.1 The most common symptom is deviates from the protocol where we intended to
chest pain, often radiating to the left shoulder or include all anxiety screening. Our inclusion criteria
angle of the jaw, and associated with nausea and were modified with the view that major depressive
sweating. Many people with ACS present with disorder is associated with negatively affecting the
symptoms other than chest pain, particularly course and outcome of ACS, and therefore it was
women, older patients, and patients with diabetes deemed appropriate to focus our understanding.
mellitus. Acute coronary syndrome is commonly However, although anxiety often coexists with
associated with three clinical manifestations, named depression, studies including anxiety alone were
according to the appearance of the electrocardio- mostly focused on quality of life and did not address
gram (ECG): STEMI, NSTEMI, or unstable our outcomes. Therefore, this review has been
angina.1 There can be some variation as to which restricted to depression or depression and anxiety,
forms of MI are classified under ACS and it should and anxiety-only studies have been excluded.15
be distinguished from stable angina, which develops
during physical activity or stress and resolves at rest. Context
In contrast with stable angina, unstable angina The context of this scoping review was the acute care
occurs suddenly, often at rest or with minimal setting (hospital wards), including acute coronary
exertion, or at lesser degrees of exertion than the care or coronary care units. Acute cardiac admis-
individual’s previous angina (‘‘crescendo angina’’).1 sions offer opportunities to screen for depression and
New-onset angina is also considered unstable anxiety, and national and international guidelines
angina, since it suggests a new problem in a coronary have previously recommended the integration of
artery.1 screening practices in the acute care of the ACS
patient.7-9,18 This scoping review, therefore, only
Concept included studies pertaining to screening of ACS
The two key concepts for this review are depression patients in the acute cardiac care setting as
and anxiety. defined above.

Types of sources were screened by three independent reviewers for

This scoping review considered quantitative, quali- assessment against the inclusion criteria (TM, SW,
tative, and mixed methods study designs for inclu- and CK), with each article being reviewed at least
sion. In addition, opinion papers (e.g. editorials) and twice. Potentially relevant articles were retrieved for
guidelines were considered for inclusion in this scop- those studies meeting the inclusion criteria (or to
ing review. Articles published in English from Janu- determine eligibility if the title and abstract did not
ary 1, 2012, to May 29, 2018, were included. This provide enough information), and the details of the
date range was chosen to include studies undertaken selected studies were imported into JBI System
during the period that guidelines, recommendations, for the Unified Management, Assessment and
and position statements addressed screening for Review of Information (JBI SUMARI; JBI, Adelaide,
depressive symptoms in ACS.7-9,18 Australia). If consensus could not be reached by the
three primary reviewers, a fourth reviewer (RAC)
Methods was called to assess the eligibility of the study. Full-
This scoping review was conducted in accordance text studies that did not meet the eligibility criteria
with JBI methodology,19 and was conducted in were excluded and reasons noted. Reasons for their
accordance with an a priori protocol.20 exclusion are provided in Appendix II.
Search strategy Data extraction

A three-step search strategy was utilized to locate Data were extracted using a data extraction tool
both published and unpublished primary studies. designed for this review (Appendix III). Data extracted
An initial limited search was conducted in Ovid included: lead author name and contact details, publi-
MEDLINE and CINAHL, using keywords related cation type and date, study location, participant
to depression, anxiety, and ACS. From the results, characteristics (number, sex, diagnoses, age), study
additional keywords and index terms were identified design and recruitment, aims and objectives, baseline
to inform the second search across all included data- screening and time(s) of follow-up, interventions, and
bases. The reference lists of all identified reports and outcome measures with findings. Data were extracted
articles were then searched for additional studies. by two reviewers (TM and SW). The third reviewer
Authors were contacted to provide further informa- (CK) then checked the data extraction tool for com-
tion where this was deemed necessary. In line with pleteness of the data. Where discrepancies were identi-
JBI scoping review methodology, one search strat- fied, they were referred to the fourth reviewer (RAC)
egy, customized for each database, was used to for resolution. Sixteen authors were contacted to clar-
search for all sources of evidence simultaneously. ify details, such as the screening tools used, where
The full search was undertaken on 1 June 2019 (full screening took place, the cut-off scores used for each
search strategies are provided in Appendix I). tool, and the balance between sexes in studies. Eight
authors responded with enough information and one
Information sources was contacted again to clarify their response. Non-
The following information sources were utilized: responding authors were not followed up.
Ovid MEDLINE, Ovid PsycINFO, EBSCO CINAHL,
Cochrane Central Register of Controlled Trials, Data presentation
Scopus, and Web of Science. Additionally, due to A narrative synthesis, supported by tabulated data,
the objective of this scoping review and the concept describing how results relate to the objectives and
focus, published guidelines and recommendations the key findings is presented.
from national and international bodies, organiza-
tions, and committees were also included, providing Results
evidence underpinning the objectives of this review. Study inclusion
The three-step systematic search identified 15,095
Study selection records and an additional 190 were identified from
Following the search, all citations were collated and clinical trials registries and gray literature sources.
uploaded into EndNote V8 (Clarivate Analytics, PA, Following the removal of duplicates, the title and
USA) and duplicates removed. Titles and abstracts abstract of 7382 articles were screened and 114 were

selected for full-text review. Three authors were three articles and these were sent to the fourth
contacted to determine where screening took place, reviewer (RAC) for adjudication that resulted in
resulting in the exclusion of one study. Overall, 63 the exclusion of one study. Fifty-one publications
studies were excluded of which 45 did not meet our were identified for inclusion in this review with the
selection criteria (six of these were studies screening first being published in 2013. A total of 21,790 ACS
for depression as an inclusion criterion for their patients were screened for either depression, or
study – not clinical care practice), 15 were incom- depression and anxiety, in an acute care setting.
plete studies (abstracts or protocols), and three were Figure 1 shows the study selection process using
duplicates of previous publications (see Appendix II the Preferred Reporting Items for Systematic
for full details of exclusion). Independent reviewers Reviews and Meta-Analyses extension for scoping
(TM, SW, and CK) disagreed on whether to include reviews (PRISMA-ScR).21
Records identified through database Additional records identified through other

Idenﬁcaon
searches sources
(n = 15,095) (n = 190)
Records after duplicates removed

(n = 7382)
Screening
Records screened Records excluded

(n = 7382) (n = 7268)
Eligibility
Full-text articles assessed for Full text articles excluded, with

eligibility reasons (Appendix II)
(n = 114) (n = 63)
• Inclusion criteria not met

(n = 45)
• Study incomplete; abstracts
or protocols (n = 15)
• Duplicate of previous study
(n = 3)
Included
Studies included in synthesis

(n = 51)
Figure 1: Search results and study selection and inclusion process21

Characteristics of included studies methodologies (prospective and retrospective) with

Forty-seven studies were primary research (see follow-ups ranging from three weeks to five years,
Table 1).22-68 Sample sizes within studies ranged were used in 20 studies,23,29,34-36,38,42-44,46-
48,54,56,60,61,63,65,67,68
from 35 to 4062, with half of studies (n ¼ 26) includ- although one of these67 fol-
ing 100 to 350 participants. Three studies had large lowed up pre-discharge without stating the time
sample sizes with more than 2700 partici- period. Two studies re-analyzed data from cohort
pants.55,56,68 Studies were conducted in 21 coun- studies,50,62 and the last study was case controlled
tries: Australia,43,44,47,61 Brazil,40,41 China,67 design with no follow-up.31 Of those reporting
Georgia,58 Germany,42 Greece,24,31 India,26,54 methods of recruitment of participants, 20 studies
Iran,33,34,52 Ireland,35 Israel,60 Italy,30,32,38,46,48,49 used consecutive recruitment. In these cases, patients
Jordan,22 Korea,65 Norway,45 Pakistan,23,25,290,37 were invited to participate as they attended at their
Poland,36,63 Taiwan,57 The Netherlands,50,59,68 cardiologist or in hospital. For the remaining studies,
Turkey,27,53,66 and the United States of America recruitment was randomized, purposive, or not
(USA),28,39, 51,56,62,64 and there was one multi- reported. Participants’ diagnoses included: PTCA,26
center trial including USA, Spain, and Australia.55 CABG,23,28,33,40,68 PCI,42,45,57,59,67 AMI,22,24,37,
50,55,56
In total, studies included 21,790 participants (age MI,29,34,36,52,53,63,68 or were referred to more
ranging 19 to 89 years) who had a confirmed broadly as ACS.25,27,30-32,35,38,39,41,44,46-51,54,58,60-
62,64
diagnosis of any ACS. Forty-four (93.6%) studies
reported the balance between sexes (38.1%
female). Review findings
Nineteen studies22,24-26,30,32,37,39-41,49,51,53,55,57- All studies screened participants for depressive dis-
59,64,66
used a cross-sectional design with one base- orders (with or without anxiety screening) either at
line assessment. Three were randomized controlled or within a few hours of admission (n ¼ 7), during
trials (RCTs) with follow-ups of one week,27 six hospitalization (n ¼ 34), or at, or just prior to,
weeks,33 and once at six weeks and then at three discharge (n ¼ 6). Twenty studies screened partici-
months post-discharge.52 One prospective observa- pants only once without follow-up. The remaining
tional study was based on an RCT with follow-up at studies screened at least twice with follow-ups rang-
five years,45 and another study was a secondary data ing from a few days to six years (see Table 1 for
analyses of an RCT.28 Observational design details).
Table 1: Characteristics of included studies

Participants
(% female)
Diagnosis Study design Baseline,
Study Location Age (years) Recruitment Aim/s and objective/s Follow-up Intervention Findings
AbuRuz et al., Jordan N ¼ 175 (28.6) Cross-sectional To examine the effects of Within 72 hours None reported Mild, moderate, or severe depressive
2018.22 MI (non-consecu- depressive symptoms on of admission symptoms: " complications (p<0.001); "
66.9 11.0 tive) in-hospital complication No follow-up length of stay; and 1.22 times " risk for
rates after AMI developing complications
Afridi et al., Karachi, N ¼ 134 (15.7) Observational To compare the frequency Pre-operative None reported " depression (98.5%) during peri-opera-
2016.23 Pakistan CABG (first (consecutive) of depression at three Follow-up: dis- tive period. Prevalence # with time; pre-
event) time points charge, six discharge (80.6%); post-operatively
53.7 8.56 months (16.4%)
Alexandri et al., Greece N ¼ 148 (41.2) Cross-sectional To explore depression and Third day in hos- None reported Depression (38%); anxiety (52%) was
2017.24 MI (non-consecu- anxiety pital associated with in-hospital use of anxioly-
(first event) tive) No follow-up tics (p ¼ 0.005) and antidepressant medi-
18 cation (p ¼ 0.026), difficulties they would
face in social and familial environment
(p ¼ 0.009 and p ¼ 0.002, respectively)
and whether patients considered them-
selves to be anxious (p ¼ 0.003).
Alvi et al., Pakistan N ¼ 200 (37.5) Comparative, To examine the associa- In hospital None reported 19.5% study population screened positive
2016.25 ACS cross-sectional tion of depression with No follow-up for depression. Depression was associ-
56 12 (non-consecu- sex, chronic conditions, ated with being female, a smoker, and
tive) and cardiovascular risk physically inactive (p < 0.05).
factors

Table 1: (Continued)
Participants
(% female)
Chaudhury et al., India N ¼ 35 (0) Cross-sectional To study the relationship Three days after None reported Prior to PTCA, 18 (32.1%) patients had
2013.26 PTCA (consecutive) of anxiety, depression, PTCA definite depression and after successful
60.9 10.8 and health-related QoL No follow-up PTCA, two (3.6%) patients continued to
have definite depression. No patients
had any complications after PTCA; all
were successful.
Demircelik et al., Turkey N ¼ 100 (36.0) RCT To evaluate the effective- During ICU None reported Participants who received the multimedia
2016.27 ACS ness of an accessibility- admission nursing education compared to those
(IG) 59 13 enhanced multimedia Follow-up: one- who did not had higher differences in
(CG) 62 10 informational educational week post HADS-A and HADS-D scores (4.2 0.58
program in reducing discharge vs. 0.6 0.42; p < 0.01 and 2.2 0.53 vs.
depression and anxiety 0.64 0.46; p < 0.01; respectively).
Doering et al., Los Angeles, N ¼ 251 (27.0) Secondary analy- To describe trajectories of Prior to dis- None reported Persistent (16.3%) or " depressive symp-
2014.28 USA ACS sis from an RCT depressive symptoms and charge toms (15.3%) from hospital discharge to
67.3 9.5 pain and to examine the Follow-up: six six weeks.
relationship of persistent weeks From discharge to six weeks, patients
depressive symptoms to with persistent depressive symptoms sus-
pain tained " between group differences in
pain interference and pain severity
(p < 0.001 and p < 0.003, respectively).
Fattah et al., Peshawar, N ¼ 100 (22.0) Comparative, To investigate the fre- In hospital Patients with MI IG # depression and BDI score
2016.29 Pakistan MI (first event) observational quency of depression and Follow-up: three and depression (p0.0001)
56.1 10.9 (non-consecu- anxiety weeks underwent
tive) psychotherapy
Felice et al., Italy N ¼ 111 (22.5) Cross-sectional To investigate relation- Three to four None reported n ¼ 57 patients with either lifetime, cur-
2015.30 ACS (consecutive) ships between the level of days after rent mood, or anxiety disorder at the
59 10 circulating EPCs and admission time of inclusion to the study. Circulating
depression and anxiety No follow-up EPC was found to be # in ACS patients
with anxiety and depression.
Georgousopou- Greece N ¼ 1000 (30.6) Case-control To investigate effect of Within first None reported Anxiety and depression mediators in
lou et al., ACS (1:1:2) Mediterranean diet on three days in protective relationship between adher-
2014.31 60 12 (consecutive) likelihood of non-fatal CV hospital ence to Mediterranean diet and risk of
outcome, anxiety, and No follow-up CVD.
depression
Giammanco Catania, N ¼ 200 (47.0) Cross-sectional To investigate two possi- In hospital None reported Depression – 53%; anxiety – 39% Uncer-
et al., 2016.32 Italy ACS (convenience) ble determinants of anxi- No follow-up tainty of illness is associated with cross-
19 - 87 ety and depression – ing borderline thresholds for depression
uncertainty in illness and and anxiety.
coping strategies
Hoseini et al., Shiraz, Iran N ¼ 70 (31.4) RCT To assess the impact of In hospital Audiotape edu- # anxiety for IG (p < 0.0001)
2013.33 CABG audiotape education pro- Follow-up: six cation program " depression for CG (p < 0.0001)
52.5 - 70.3 gram (IG) on anxiety and weeks given after
depression surgery
Hosseini et al., Iran N ¼ 285 (30.9) Observational To compare case-level and Two to 15 days None reported Depression was a predictor of death;
2014.34 MI (consecutive) comorbid anxiety and of hospital anxiety was not. After adjusting for
59.1 12 depression on predictors admission disease severity and confounders, this
of mortality over five Follow-up: five became non-significant.
years’ follow-up in MI years
patients
Keegan et al., Dublin, N ¼ 347 (21.0) Prospective To investigate hypothe- During hospitali- None reported Depressive symptom trajectories and
2016.35 Ireland ACS observational sized significant associa- zation morbidity/mortality were predicted by
61.4 10.5 (consecutive) tions among theoretical Follow-up: three, theoretical vulnerabilities.
vulnerabilities, depression six and 12
trajectories, and poor clin- months
ical outcomes
Kroemeke, Warsaw, N ¼ 200 (29.5) Observational To identify subpopulations Prior discharge None reported # depressive symptoms one-month post
2016.36 Poland MI (NR) with different depression (a few days after MI, which remained unchanged at
53.7 7.3 trajectories and evaluate MI) follow-ups.
the effects of coping vari- Follow-up: one
ables on different patterns and six months,
of depression six years
Maqsood et al., Abbottabad, N ¼ 246 (47.1) Cross-sectional To determine the fre- Third day of hos- None reported Frequency of depression in study partici-
2017.37 Pakistan Acute MI (consecutive) quency of depression pital admission pants with acute MI was 27.24%
56.0 5.2 No follow-up (n ¼ 67).
Marchesi et al., Parma, Italy N ¼ 250 (18.8) Observational To verify whether, in Prior discharge Patients with 4.8% of study participants had major
2014.38 ACS (consecutive) never-depressed subjects, Follow-up: one, severe depres- depression and 7.2% had minor depres-
(first event) TDP predicts the develop- two, four, six sive symptoms sion. The development of depressive
61.1 11.2 ment of a depressive dis- months were referred to symptoms was not predicted by TDP in
order (major and minor psychiatrist for never-depressed patients.
depression) proper treat-
ment

Participants
(% female)
McGuire et al., USA N ¼ 101 (30.7) Cross-sectional To evaluate nurse-adminis- Prior discharge Patients with a Each version of the PHQ yielded "
2013.39 ACS comparative tered depression screen- No follow-up positive screen symptom scores in depressed compared
18 design (consecu- ing on the PHQ-2 to non-depressed patients: PHQ-2 scores,
tive) were given an 3.4 vs 0.6, p ¼ 0.001; PHQ-9 scores, 13 vs
information 3.4, p < 0.001; and PHQ-10 scores, 14.5
sheet and vs 3.6, p < 0.001.
instructions to
discuss with
their healthcare
provider
Mendonca da Brazil N ¼ 63 (39.7) Cross-sectional To assess presence of Pre-operative None reported 36.5% dysphoria and 25.4% some degree
Cunha et al., CABG (non-consecu- depressive symptoms No follow-up of depression (6.3% mild, 17.5% moder-
2016.40 58.2 13.0 tive) ate, 1.6% severe)
# educational level presented " depres-
sive symptoms.
Meneghetti Brazil N ¼ 91 (35.2) Cross-sectional To investigate the preva- 48 hours after None reported Prevalence of symptoms of anxiety 48.4%
et al., 2017.41 ACS prevalence (con- lence of anxiety and admission (n ¼ 44) and prevalence of depressive
64.0 9.2 venience) depression and to exam- No follow-up symptoms 26.4% (n ¼ 24).
ine associations with use
of psychotropic drugs
Meyer et al., Germany N ¼ 470 (23.2) Prospective (con- To determine impact In hospital None reported Significant difference in mortality
2014.42 PCI secutive) (mortality) of depressive two, five years (depressed to non-depressed) at two
63.7 9.9 symptoms on long-term years; non-significant at five years.
survival
Murphy et al., Melbourne, N ¼ 163 (100) Observational To investigate depression In hospital None reported Mortality was predicted by mild in-hospi-
2013.43 Australia AMI/CABG (consecutive) as a predictor of 12-year Follow-up: two tal HADS-D scores (p ¼ 0.02) and at two
67.7 10.2 mortality months months follow-up moderate/severe
HADS-D scores (p ¼ 0.05).
Murphy et al., Regional N ¼ 160 (32.0) Observational To identify the trajectories Prior discharge None reported In-hospital anxiety symptoms persisted
2014.44 Victoria, ACS (consecutive) of anxiety and depression Follow-up: two, over time; in-hospital depression symp-
Australia 67.6 11.5 symptoms during the six six months toms resolved for some patients (54%)
months after an acute car- and worsened for those who had mild
diac event with a view to initial symptoms (29%). Those with "
identifying patients at risk initial symptoms (17%) showed a quick
of persistent or worsening and continued improvement that
symptoms; and to identify resolved at six months.
the in-hospital red flags
that signal persistent or
worsening symptoms of
anxiety and depression
Olsen et al., Norway N ¼ 775 (24.8) Prospective To compare prevalence of In hospital None reported " depression and anxiety in CR partici-
2018.45 PCI observational anxiety and depression in Follow-up: five pants compared to non-participants
64.0 9.2 (based on RCT) cardiac rehabilitation and years (baseline, three years)
the general population, " anxiety in PCI patients compared to
and to identify predictors general population (baseline)
of symptomatic anxiety # (p < 0.001) depression and anxiety in
and depression all participants (from baseline to three
years).
Ossola et al., Parma, Italy N ¼ 304 (19.4) Observational To identify risk factors for In hospital None reported " risk of major depression for women
2015.46 ACS (consecutive) incident depression Follow-up: one, (p ¼ 0.02), widowed (p < 0.001) and
(first event) two, four, six, those with loss of positive affectivity and
50.3 - 75.9 nine and 12 anxiety (p < 0.01) a few days after ACS.
months
Parker et al., Australia, N ¼ 332 (20.5) Observational To examine the associa- 4.5 days post None reported Depression present immediately prior,
2018.47 Sydney ACS (consecutive) tion between lifetime admission during or within one month after ACS is
65 depression and depression Follow-up: one a strong predictor of poor one-year
at time of ACS and 12 months cardiac outcome.
Patron et al., Italy N ¼ 96 (29.0) Prospective To examine whether pre- Pre-operative None reported 27 (28%) and 24 (25%) depression preop-
2014.48 ACS observational existing depression rather Follow-up: three eratively and at three-month follow-up.
63.6 10.7 (non-consecu- than perioperative vari- months Postoperative depression predicted by
tive) ables may predict postop- preoperative CES-D. Reactive depression
erative reactive or " European System for Cardiac Operative
persistent depression Risk Evaluation; Persistent depression "
pre-operative CES-D scores than those
whose depression improved after surgery
(p < 0.01).
Pini et al., Italy N ¼ 118 (17.8) Cross-sectional To evaluate the relation- In hospital None reported Depression and anxiety results not
2015.49 ACS (first event) (NR) ship between complicated No follow-up reported.
47.9 - 73.5 grief and ACS outcomes

Participants
(% female)
Roest et al., The N ¼ 457 (18.8) Re-analysis of To determine whether MI In hospital None reported No significant associations found.
2016.50 Netherlands AMI cohort (non- patients can be classified Follow-up: three,
61.0 11.4 consecutive) based on concurrent six and 12
course trajectories of months
depressive symptom
dimensions (cognitive/
affective and somatic/
affective)
Sanner et al., Houston, N ¼ 377 (100) Cross-sectional To explore depressive In hospital None reported Symptoms of depression are common in
2013.51 USA ACS (non-consecu- symptoms during hospital- No follow-up women and vary by age (p < 0.0001)
64 13 tive) ization. Self-reported depressive symptoms "
CAD (p ¼ 0.0118)
Sararoudi et al., Iran N ¼ 48 (NR) RCT To evaluate the effect of Admission Educational IG # days off work (28.7 8.1 days vs
2016.52 MI illness perception focused Follow-up: six intervention CG: 46 7.6)
(IG) 54.8 7.6 intervention on quality of weeks, three IG # anxiety (IG: 8.3 3.3 vs CG:
(CG) 49.9 10.6 life, anxiety, and depres- months 15.8 2.1)
sion IG # depressive symptoms (6.8 3.5 vs
CG: 17.1 2.3)
IG # illness perceptions (36.5 5 vs CG:
41.9 4)
Sertoz et al., Turkey N ¼ 998 (20.8) Cross-sectional To evaluate the impact of In hospital None reported Depression had negative impact on QoL.
2013.53 MI (consecutive) depression and physical No follow-up
57.5 10.1 comorbidity on QoL
Shruthi et al., India N ¼ 248 (19.8) Observational To evaluate psychiatric Prior discharge None reported Depression persisted in a significant num-
2018.54 ACS (consecutive) comorbidities Follow-up: three, ber of patients during the study. The
20 - 79 six months severity of depression was more during
the three-month follow-up time than
compared to the end of six months.
Smolderen et al., USA, Spain, N ¼ 3572 (67.1) Cross sectional To evaluate depressive During admission None reported A higher proportion of women (48%)
2015.55 and AMI (non-consecu- symptom burden, examine or shortly after compared to men (24%) reported life-
Australia 18 - 55 tive) the associations with No follow-up time history of depression (p < 0.0001).
demographic, socioeco- Increased depressive symptoms was
nomic, and clinical pro- related to higher levels of stress and
files, and the association poorer QoL (P < 0.001).
between sex and depres-
sive symptoms
Smolderen et al., USA N ¼ 4062 (33.0) Observational To examine one-year mor- 24 to 72 hours None reported 18.7% had a PHQ-9 positive-screen of
2017.56 AMI multi-center tality rates between after admission which 30.4% were treated for depression.
18 cohort study patients with treated vs. Follow-up: one, Those with untreated depression had
(non-consecu- untreated depression six, 12 months higher unadjusted mortality rates. Case
tive) note assessment of treatment and cate-
gorization into treated or untreated.
Su et al., 2018.57 Taiwan N ¼ 105 (23.8) Cross-sectional To identify the predictors In hospital None reported 61% had depressive symptoms (predic-
PCI (NR) of depression No follow-up tors; social support, unstable angina,
64.4 13.7 stroke history).
28.6% had moderate depression.
Tatishvili et al., Georgia N ¼ 84 (21.0) Cross-sectional To identify factors associ- In hospital None reported Mean depression score was 13.0, BDI
2016.58 ACS (non-consecu- ated with depressive epi- No follow-up score >16 was revealed in 28.8% of
58.2 10.2 tive) sode patients.
Women " depressive symptoms (BDI
>16); 70% # ejection fraction (<40%)
had depressive score (>16)
van Montfort The N ¼ 492 (19.0) Cross-sectional To determine ability of Within one-week None reported Recommendation: use a multidimensional
et al., 2017.59 Netherlands Elective or active (non-consecu- ESC psychosocial screening post PCI (elec- psychosocial screening instrument instead
PCI tive) instrument to identify tive); one month of just information on depression and/or
65.2 9.5 sub-groups of patients later (acute) anxiety.
with CHD No follow-up
Vilchinsky et al., Israel N ¼ 397 (15.1) Observational To explore the putative In hospital None reported 76.8% and 63.0% had at least one
2018.60 ACS (non-consecu- contribution of symptoms Follow-up: six symptom of anxiety and depression
59.5 10.8 tive) of depression and anxiety weeks (respectively). Symptoms of depression,
to CPRP participation but not anxiety, were more frequently
observed in Arab patients compared to
Jewish patients.
Vollmer-Conna Sydney, N ¼ 328 (20.7) Observational To examine major depres- 4.5 (4.2) days None reported Depression in ACS is likely to be a
et al., 2015.61 Australia ACS (consecutive) sive episodes after ACS after cardiac consequence of an array of vulnerabilities
18 - 89 event (biological, psychological, behavioral).
Follow-up: one
month

Participants
(% female)
Whang et al., New York, N ¼ 769 (34.8) Secondary analy- To assess ECG markers Within one week None reported " depression in females (p < 0.01)
2016.62 USA ACS sis of prospec- with LVH and depression after index
50.5 - 74.4 tive cohort (non- event
consecutive) No follow-up
Wilkowska et al., Poland N ¼ 37 (22.0) Observational To evaluate morning and Fifth day of hos- None reported 34.4% of the patients had a BDI score
2017.63 MI (first event) (non-consecu- afternoon serum cortisol pitalization 10 and there was a statistically significant
51.9 - 57.5 tive) concentrations as parame- Follow-up: three, difference between the mean morning
ters of the HPA axis func- six months and the evening plasma concentrations
tion, compared to in depressed patients compared to non-
patients after MI without depressed patients p ¼ 0.0328).
depression.
Yammine et al., USA N ¼ 153 (44.4) Cross-sectional To explore the relationship Within two to None reported Mean BDI-II score was 13.67
2014.64 ACS (non-consecu- of depressive symptom five days of (SD ¼ 10.76). Classified BDI-II score was
45.9 5.97 tive) severity to circulating admission related to ET-1T in both unadjusted
endothelin (ET)-1 No follow-up (p ¼ 0.024) and multivariable (p ¼ 0.038)
models, with ET-1T being significantly
higher in patients with severe depressive
symptoms than in those with mild and
moderate depressive symptoms.
Yu et al., 2017.65 Korea N ¼ 221 (34.4) Prospective lon- To examine existence of In hospital None reported Baseline ventricular ejection fraction
PCI gitudinal (non- depressive symptoms and Follow-up: one <60% and positive screen for depressive
20 consecutive) the combined effect of month symptoms at one-month post-discharge
low baseline LVEF and were correlated with increased incidence
post-cardiac depressive of major adverse cardiac events after PCI
symptoms (hazard ratio: 4.049; 95% confidence
interval: 1.365 to 12.011).
Yüksel et al., Turkey N ¼ 63 (21.0) Cross-sectional To determine whether Pre-operative None reported There were no significant differences in
2016.66 elective CABG (non-consecu- experiencing ACS prior to No follow-up BDI scores between groups (i.e. Group 1
20 tive) open heart surgery affects patients receiving CABG after an ACS
patients in terms of diagnosis vs Group 2 patients who
depression, hopelessness, received CABG after ischemic heart dis-
anxiety, fear of death, and ease diagnosis).
QoL
Zhang, 2015.67 China N ¼ 150 (NR) Observational Assess anxiety and depres- One day after 50% of partici- Study included patients who received
CAD undergoing (non-consecu- sion and study the effects admission pants received stent implantation during coronary angi-
PCI tive) of psychological interven- Follow-up: educational ography n ¼ 100 and the non-stent group
18 tion pre-discharge material regard- (50 cases). Among the stent group,
ing condition, n ¼ 50 were randomly selected to receive
treatment, prog- a postoperative psychological interven-
nosis and reha- tion; the remaining 50 patients did not
bilitation; addi- receive the intervention. No significant
tional reassur- differences in anxiety and depression
ance through scores in the intervention compared to
pre- and post- the non-intervention group (p>0.05).
operative com- Anxiety and depression scores were sig-
munication; nificantly lower on day of discharge
relaxation ther- compared other groups.
apy and individ-
ualized rehabili-
tation training
Zuidersma et al., The N ¼ 2704 (NR) Cohort (consecu- To evaluate the indepen- In hospital Depressed Self-reported depressive symptoms are a
2013.68 Netherlands MI tive) dent impact of a diagnosis Follow-up: three patients random- more accurate predictor of cardiac mor-
18 of clinical depression and months ized to receive tality and morbidity than presence of
self-reported depressive intervention clinical depression.
symptoms evaluating the
effects of anti-
depression treat-
ment compared
to usual care
ACS: acute coronary syndrome; AMI: acute myocardial ischemia; BDI: Beck Depression Inventory; CABG: coronary artery bypass grafting; CAD: coronary artery disease;
CES-D: Center for Epidemiologic Studies Depression Scale; CG: control group; CHD: coronary heart disease; CPRP: certified psychiatric rehabilitation practitioner; CR:
cardiac rehabilitation; CV: cardiovascular; CVD: cardiovascular disease; ECG: electrocardiograph; EPC: enhanced primary care; ESC: European Society of Cardiology; ET:
endothelin; HADS: Hospital Anxiety and Depression Scale; HPA: hypothalamic-pituitary-adrenal; ICU: intensive care unit; IG: intervention group; LVEF: left ventricular
ejection fraction; LVH: left ventricular hypertrophy; MI: myocardial infarction; NR: not reported; PCI: percutaneous coronary intervention; PHQ: Patient Health
Questionnaire; PTCA: percutaneous transluminal coronary angioplasty; QoL: quality of life; RCT: randomized controlled trial; SD: standard deviation; TDP: Type D
personality.
Note: Where data are missing, author was unable to be contacted.

Depression screening in acute conorany for depression in the medically ill – short version
syndrome (DMI-10).47 The Hamilton Depression Rating Scale
A total of 17 instruments were reported to screen for was used in three studies from two countries.30,49,54
depression. The most commonly used tools for Two studies also used the Primary Care Evaluation
depression screening were the Beck Depression of Mental Disorders questionnaire during assess-
Inventory (BDI) (16 studies; n ¼ 7063); the HADS ment; Ossola et al.,46 in Italy, determined that
(14 studies; n ¼ 2774), and versions of the PHQ scoring more than one episode indicated depression;
(eight studies; n ¼ 8753). however, no details were given on scoring in the
Of the 47 included studies, 18 used a version of the other study.38 The remaining studies also used
HADS to screen for depressive symptoms and/or screening tools that appeared in their study only.
anxiety. These studies were undertaken in In an Israeli study, Vilchinsky et al.60 used the Brief
Australia,43,44 Brazil,41 Greece,24 India,26,54 Symptom Inventory (Depression); in a study from
Iran,33,52 Ireland,35 Italy,30,32,38,46,49 Norway,45 China, Zhang67 used a Self-Rating Depression Scale;
Pakistan,23,37 and Turkey.27 The HADS can be Patron et al.,48 in Italy, used the Center for Epide-
administered as one questionnaire, which includes miologic Studies Depression Scale; another Italian
two sub-scales: the HADS-D (seven-item depression study by Felice et al.30 utilized the Structured Clini-
scale) and the HADS-A (seven-item anxiety scale). In cal Interview for Psychiatric Disorder; and Georgou-
some studies, the authors chose to use only one of the sopoulou et al.,31 in Greece, used the Zung
sub-scales. Sixteen included studies screened using a Depression Rating Scale.
form of the BDI. These studies were conducted in
Brazil,40 Georgia,58 Iran,34 Ireland,35 Jordan,22 Anxiety screening in acute coronary syndrome
Pakistan,29 Poland,36,63 The Netherlands,50,68 Tools to screen for anxiety were more varied, with
Turkey,53,66 and the USA.28,51,62,64 An Irish study eight tools identified across 14 studies. The State-
assessed for depressive symptoms using the Beck Trait Anxiety Inventory (STAI-1) was used in three
Depression Inventory – Fast Screen (BDI-FS).35 A studies,34,48,66 measuring 444 participants (29.0%
study in Turkey by Yüksel et al.66 reported using the female), and the CCAS was used in another three
Beck Depression Scale with little further information studies,47,59,61 screening 1152 participants (22.0%
provided. female). Two studies30,49 used the Hamilton Anxiety
Three versions of the PHQ were used; the PHQ- Rating Scale (n ¼ 229; 20.1%), and another two
2, the PHQ-9, and the PHQ-10. The little-used studies28,60 (n ¼ 648; 19.7% female) used the
PHQ-10 includes all PHQ-9 questions plus an Brief Symptom Inventory Anxiety Scale (6-item).
additional item to assess the degree to which Georgousopoulou et al.31 (n ¼ 1000; 30.6%
depressive symptoms interfere with daily function- female) and Hosseini et al.34 (n ¼ 285; 30.9%
ing. In the USA, McGuire et al.39 used all three female) used the State Trait Anxiety Inventory
versions (PHQ-2, PHQ-9, and PHQ-10), as well as (STAI Y-2). Murphy et al.44 used the HADS-A
the Mini-Mental State Examination, to evaluate (n ¼ 160; 32.0% female), Giammanco et al.34 used
nurse-administered depression screening and found the EuroQoL 5D (n ¼ 200; 47.0% female), and
no significant differences between the versions of finally, in 150 participants (percent female not
the PHQ administered, although each version of the reported) the Self-Rating Anxiety Scale was used.67
PHQ yielded higher symptom scores in depressed In addition, 11 studies24,26,27,32,33,38,41,44-46,52
patients than in non-depressed patients. A study used the full version of the HADS (HADS-D and
that was conducted in the USA, Spain, and HADS-A), which also screens for anxiety, screen-
Australia also included the PHQ-9 (cut-off greater ing 2181 participants (30% female). Table 2
than or equal to 10).55 provides full details of all depression and anxiety
Three studies, two in Australia,47,61 and one in screening tools used.11,16,17,69-86
India,54 used the Mini-International Neuropsychiat-
ric Interview to assess for depression; both Austra- Integration of screening for depression and anxiety
lian studies also used the Costello and Comrey into acute coronary syndrome models of care
Anxiety Scale (CCAS), and Vollmer-Conna et al.61 Studies reported that screening took place at
also used the cognitively based measure for screening various times during the patient’s acute care.

Table 2: Summary of instruments used for depression screening among patients with acute coronary
syndrome
Screening tool Cut-off score Author, date (country)

Depression screening
BDI69 10 Mendonca, 2016 (Brazil)40; Hosseini, 2014 (Iran)34;
Kroemeke, 2016 (Poland)36; Wilkowska, 2017
(Poland)63; Roest, 2016 (The Netherlands)50; Sertoz,
2013 (Turkey)53; Doering, 2014 (USA)28; Whang,
2016 (USA)62
BDI69 11 Fattah, 2015 (Pakistan)29
BDI69 16 Tatishvili, 2016 (Georgia)58
69
BDI 17 Yüksel, 2017 (Turkey)66
BDI69 19 Zuidersma, 2013 (The Netherlands)68
70
BDI-II 10 AbuRuz, 2018 (Jordan)22
BDI-II70 14 Mendonca, 2016 (Brazil)40; Sanner, 2013 (USA)51;
Yammine, 2014 (USA)64
BDI-Fast Screen71 – six-item scale >3 Keegan, 2016 (Ireland)35
72
BSI-Depression 1 symptom Vilchinsky, 2018 (Israel)60
CESD73 16 Patron, 2014 (Italy)50
74
DMI-10 9 Vollmer-Conna, 2015 (Australia)61
HADS17 8 Murphy, 2014 (Australia)44; Meneghetti, 2017
(Brazil)41; Alexandri, 2017 (Greece)24; Hoseini, 2013
(Iran)33; Sararoudi, 2016 (Iran)52; Ossola, 2015
(Italy)46; Giammanco, 2016 (Italy)32; Olsen, 2018
(Norway)45; Demircelik, 2016 (Turkey)27
HADS17 > 10 Marchesi, 2014 (Italy)38
HADS17 Not reported Chaudhury, 2013 (India)26
17
HADS-D – depression subscale 4 Murphy, 2013 (Australia)43
HADS-D17 – depression subscale >7 Keegan, 2016 (Ireland)35
17
HADS-D – depression subscale 8 Murphy, 2013 (Australia)43; Meneghetti, 2017
(Brazil)41
HADS-D17 – depression subscale 11 Masqood, 2017 (Pakistan)37
HAM-D75 6 Pini, 2015 (Italy)49
75
HAM-D 8 Afridi, 2016 (Pakistan)23
75
HAM-D 9 Felice, 2015 (Italy)30
HAM-D75 Not reported Shruthi, 2018 (India)54
76
MINI Five of nine Vollmer-Conna, 2015 (Australia)61
symptoms over a
two-week period
MINI76 Not reported Parker, 2018 (Australia)47
76
MINI Not reported Shruthi, 2018 (India)54
PHQ-II (PHQ-2)16 3 McGuire, 2013 (USA)39

11
PHQ-9 10 Alvi, 2016 (Pakistan)25; Su, 2018 (Taiwan)57; McGuire,
2013 (USA)39; Smolderen, 2017 (USA)56; Smolderen,
2015 (USA, Spain, Australia)55

Screening tool Cut-off score Author, date (country)

11
PHQ-9 Mean score van Montfort, 2017 (The Netherlands)61
11
PHQ-9 (Korean Version) 5 Yu, 2017 (Korea)65
PHQ-10 Not reported McGuire, 2013 (USA)39
77
PRIME-MD 1 episode Ossola, 2015 (Italy)46
PRIME-MD77 Not reported Marchesi, 2014 (Italy)38
78
Self-rating Depression Scale Not reported Zhang, 2015 (China)67
79
SCID-I Not reported Felice, 2015 (Italy)30
ZDRS (Self-Rating Depression Scale)78 50 Georgousopoulou, 2014 (Greece)31
Anxiety screening
BSI – Anxiety Scale (6 item)80 1 symptom Vilchinsky, 2018 (Israel)60
80
BSI – Anxiety Scale (6 item) Not reported Doering, 2014 (USA)28
CCAS81 Not reported Vollmer-Conna, 2015 (Australia)61
81
CCAS Not reported Parker, 2018 (Australia)47
CCAS81 Mean score van Montfort, 2017 (The Netherlands)59
17
HADS-A 8 Murphy, 2014 (Australia)44
HAM-A82 Not reported Felice, 2015 (Italy)30
82
HAM-A 18 Pini, 2015 (Italy)49
Self-Rating Anxiety Scale83 Not reported Zhang, 2015 (China)67
84
STAI-1 20 Patron, 2014 (Italy)48
STAI-184 40 Hosseini, 2014 (Iran)34
84
STAI-1 43 Yüksel, 2017 (Turkey)66
STAI Y-285 40 Georgousopoulou, 2014 (Greece)31; Hosseini, 2014
(Iran)34
EQ-5D86 0 (worst) – 100 Giammanco, 2016 (Italy)32
(perfect)

Includes the HADS-A and HADS-D subscales. Includes all PHQ-9 questions plus an additional item to assess the degree to which depressive symptoms interfere
with daily functioning.
BDI: Beck Depression Inventory; BSI: Brief Symptom Inventory; CCAS: Costello and Comrey Anxiety Scale; CESD: Center for Epidemiologic Studies Depression scale;
DMI: depression in the medically ill; EQ-5D: EuroQoL 5D; HADS: Hospital Anxiety and Depression Scale; HAM-D: Hamilton Depression Rating Scale; MINI: Mini-
International Neuropsychiatric Interview; PHQ: Patient Health Questionnaire; PRIME-MD: Primary Care Evaluation of Mental Disorders; SCID-I: Structured Clinical
Interview for Psychiatric Disorders; STAI: State Trait Anxiety Inventory; ZDRS: Zung Depression Rating Scale.
Four studies reported undertaking screening (Table 2). For example, in this review there are 16
pre-operatively,23,40,48,66 four at or shortly after studies that used either the BDI or the BDI-II, with
admission,27,52,55,67 and five at or prior to dis- seven different cut-off scores. Eight studies used a
charge.28,38,39,44,54 The remaining studies reported cut-off score of 10 to indicate the presence of
undertaking screening during hospitalization depressive symptoms28,33,36,40,50,53,62,63; however,
with five studies stipulating post-ACS event four other studies used cut-offs of 11,29 16,58
screening.26,38,59,61,62 17,66 and 19.68 A further four studies used the
BDI-II; three used a cut-off score of 14,40,51,64 and
Variation on implementation of screening the other determined depression at a score over
instruments nine.22 Apart from one study that used a cut-off
There was also significant variation found in cut-off 10,38 and another that did not report a cut-off
values used for determining depression and anxiety score,26 all studies used 8 to determine depression
between studies when using the same screening tools when using the HADS (Table 2).

Where only the Depression Subscale (HADS-D) In a study of biomarkers,61 a unique biological
of the HADS was used, the cut-offs varied from signature for ACS-associated depression was unable
study to study: 4,43 > 7,35 and 11.37 An Irish to be identified by immunological, autonomic, or
study assessed for depressive symptoms using the nutritional parameters included in a consecutively
HADS-D prior to discharge, using a score of > 7 to recruited sample of ward patients. Patients were
indicate major depressive disorder.35 Murphy screened for current and lifetime history of depres-
et al.43 defined depression using a HADS-D score sion; however, results were reported in terms of
of 0 to 3 for non-depressed, 4 to 7 for mild depres- associated factors (younger age, higher levels of
sion, and 8 moderate to severe depression; how- C-reactive protein, lower abnormal heart rate char-
ever, it was noted that in cardiac patients a score of acteristics, and lower levels of vitamin D). Other
6 is the recommended cut-off for detection of studies reported outcomes in terms of morning and
anxiety, and a score of 4 for depression. The same afternoon serum cortisol concentrations as parame-
study used the HADS-A to determine anxiety, ters of the hypothalamic-pituitary-adrenal axis func-
reporting 8 as the cut-off (Table 2). tion in patients with depression after MI,63
predictors (social support, unstable angina, stroke
Additional findings from screening studies history) of depression,57 psychosocial distress risk
Smolderen et al.55 explored lifetime history of depres- among CAD patients,59 ECG analysis and associa-
sion and depressive symptoms experienced over the tions with sex and/or race, diabetes mellitus and
two weeks preceding hospitalization for AMI. A high smoking,62 and depression comorbid conditions.53
proportion of women (48%; n ¼ 1150) reported a
lifetime history of depression compared to one-fourth Models of care and clinical pathways
of men (24%; n ¼ 282). Similarly, more women Some studies included interventions for patients. Four
reported current depressive symptoms (39%; studies applied an intervention for those found to have
n ¼ 935) compared to 22% of men (n ¼ 258). depression; two were RCTs with interventions target-
Adopting a cross-sectional design, Mendonca da ing depression,33,52 and two were comparative
Cunha et al.40 examined whether depressive symp- designed cross-sectional studies using an interven-
toms were present in 63 hospitalized patients prior to tion.39,67 Sararoudi et al.52 sought to evaluate the
CABG. The authors examined socio-demographic effect of an illness-perception-focused intervention
factors and assessed depression using the BDI pre- on quality of life, anxiety, and depression in MI
operatively; the study identified 36.5% (n ¼ 23) of patients. The intervention group received three half-
patients classified with dysphoria, and one-fourth hour training sessions for three consecutive days to
had some degree of depression (6.3% mild, 17.5% understand the disease. These were implemented
moderate, and 1.6% severe). Sanner51 reported at admission, six weeks, and three months post-
cross-sectional results from 377 adult women, show- discharge. This study found that mean duration of
ing that symptoms of depression are common in returning to work was significantly lower for the
women and vary significantly by age. Self-reported intervention groups. Furthermore, the intervention
depressive symptoms increased significantly for cor- group showed significantly decreased anxiety,
onary artery disease (CAD) patients (37.6%; n ¼ 70) depression, and illness perceptions scores.
compared with women with no self-reported history Hoseini et al.33 reported that an audiotape educa-
of CAD (25.5%; n ¼ 48); however, no treatment tional program used by patients after CABG surgery
recommendations were reported. decreased levels of anxiety and depression. Authors
In a study that followed 160 patients in the acute demonstrated that at six weeks post-intervention,
phase of hospitalization for ACS, Murphy et al.44 anxiety levels were lower in the intervention group
found that in-hospital anxiety symptoms tended to and that educational interventions after discharge can
persist over time, whereas in-hospital depression be used to reduce anxiety in patients who have under-
symptoms resolved for some patients (54%; gone CABG. Authors reported that their results were
n ¼ 86) and worsened for those who had mild initial in line with Sharif et al.87 and Fredericks et al.,88 who
symptoms (29%; n ¼ 46). Those with high initial demonstrated cardiac rehabilitation is effective for
symptoms (17%) showed a quick and continued anxiety and depression in patients undergoing
improvement that resolved at six months. CABG. A comparative designed study measured the

frequency of depression and assessed the benefits of a post-operative psychological intervention that
short-term psychotherapy intervention in post MI,29 included educational material regarding condition,
using a pre- and post-design to assess depression with treatment, prognosis, and rehabilitation; additional
the BDI tool. Authors found that three therapeutic reassurance through pre- and post-operative commu-
sessions and weekly phone calls were significantly nication; relaxation therapy; and individualized reha-
effective in reducing the level of depression in the bilitation training. The remaining 50 patients did not
intervention group (at follow-up). receive the intervention. No significant differences in
Finally, Zhang67 assessed anxiety and depression anxiety and depression scores between groups were
and the effects of a psychological intervention. Depres- found; however, anxiety and depression scores were
sion was measured on the day after admission, the day significantly lower on the day of discharge compared to
after coronary angiography, and at discharge. Patients other non-intervention groups.
were assessed using the self-rating anxiety scale and the
self-rating depression scale (cut-off score not reported). Practice gap in the screening and management
The study included patients who received stent implan- of anxiety and/or depression
tation during coronary angiography (n ¼ 100) and the Table 3 provides an overview of the remaining four
non-stent group (n ¼ 50). Among the stent group, publications (clinical practice guidelines covering
50 participants were randomly selected to receive a the period 2013 to 2016)89-92 pertaining to ACS
Table 3: Summary of acute coronary syndrome and secondary prevention guideline recommendations
for screening of depression and anxiety (2012–2019)
Recommendation for screening and management of depression and
Year/guideline anxiety Level of evidence
2016: European guidelines on Multimodal behavioral interventions, integrating health education, I A
CVD prevention in clinical physical exercise, and psychological therapy are recommended to IIa A
practice89 improve psychosocial health in patients with established CVD and IIa B
psychosocial symptoms.
Referral to psychotherapy, medication, or collaborative care should
be considered in the case of clinical symptoms of depression,
anxiety, or hostility.
Treatment of psychosocial risk factors with the aim of preventing
CAD should be considered when the risk factor itself is a diagnosable
disorder (e.g. depression) or when the factor worsens classical risk
factors.
2014: Guideline for the man- Manage comorbidities Not stated
agement of patients with non– AHA scientific statement on depression
ST elevation acute coronary
syndromes: a report of the
ACC/AHA Task Force on Prac-
tice Guidelines90
2014: ACRA core components All patients should be screened for depression and anxiety with a Not stated
of CVD secondary prevention validated assessment tool, preferably while in hospital. This should
and cardiac rehabilitation91 be repeated during and at completion of CR.
Patients screened as positive should be referred for stepped,
collaborative care that may include psychotherapy (e.g. cognitive
behavioral therapy) and/or prescription of antidepressant/
anti-anxiety medications.
2013: ACCF/AHA Guideline for Manage comorbidities Not stated
the management of ST eleva- AHA scientific statement on depression
tion MI92
ACRA: Australian Cardiovascular Health and Rehabilitation Association; ACS: acute coronary syndrome; ACC: American College of Cardiology; ACCF: American College
of Cardiology Foundation; AHA: American Heart Association; CAD: coronary artery disease; CR: cardiac rehabilitation; CVD: cardiovascular disease; MI: myocardial
infarction

management and identifying where screening and reported that women with suspected ACS are less
managing depression and anxiety is recommended. likely to be diagnosed with ACS, which has often
been attributed to atypical symptoms and less reli-
Discussion able ECG findings. Additionally, it has been reported
This review found that the use of screening tools for that women are less likely to want to participate in
depression and anxiety in ACS patients in acute cardiovascular research.96
coronary care was not uniform, and current evidence The most recent recommendation for screening of
highlights a lack of standardization for the screening depression and anxiety in ACS was in the Australian
of depression, or depression and anxiety, in the acute Cardiovascular Health and Rehabilitation Associa-
care setting for ACS patients. Where studies had used tion core components of cardiovascular disease sec-
the same tool there was, sometimes vast, variation in ondary prevention and cardiac rehabilitation,91
the methods used in administering and scoring the where it is recommended that all acute cardiac care
tool (including the cut-off scores used to determine patients be screened for depression and anxiety with
morbidity), and the interpretation of how the result a validated assessment tool, preferably while in
should be used to either diagnose depression and hospital. These recommendations also state that this
anxiety, or quantify the symptoms of each of these should be repeated during and at completion of
conditions. For example, McGuire et al.39 were clear cardiac rehabilitation. Other international guide-
that the PHQ tool was not a diagnostic instrument in lines regard screening for depression and anxiety
any version and therefore should not be used for this as management of comorbidities and not part of
purpose. They recommended that to diagnose acute cardiac management of ACS.90 Where recom-
depression the Diagnostic Interview and Structured mendations had been made for routine screening for
Hamilton be used by a diagnostic clinician. Two depression and anxiety in all patients presenting with
studies included in this review used the PHQ-9 only ACS in earlier guidelines, these were absent in cur-
and referred to their results as a diagnosis of depres- rent recommendations.7,13,89-92,97-99 Of the seven
sion.25,56 Most studies in this review, however, guidelines published since 2012,13,89-92,97,98 three
screened for depressive symptoms rather than diag- (43%) did not contain any recommendations on
nosis using the BDI or the HAM-D as a screening screening for depression and anxiety,13,97,98 only
tool for depressive symptoms, or the PHQ-2 or four (57%) had recommendations for treatment
PHQ-9, which can also be completed online by of comorbidities, and two societies (American
patients. Although the PHQ does not diagnose, it Heart Association and European Society of Cardi-
has good specificity and sensitivity when used to ology) had additional guidelines specifically for
screen for depressive symptoms.93 depression and anxiety in ACS7,92; however, these
The most common design in the included studies were published prior to the search date of this
for this review was a cross-sectional examination of scoping review.
dependent or independent relationships with depres- The inconsistency in the application of screening
sion or anxiety, measured with one or more self- practices for depression and anxiety in ACS
reported instruments. A minority of the research was patients has highlighted the importance of issuing
concerned with the diagnosis, treatment, and/or evidence-based guidance on how practitioners
management of depression and anxiety in ACS screen for depression and anxiety in this popula-
patients. Follow-up interventions were not reported tion, and what tools, or collection of tools, are
in 85% of studies. This current review also found an recommended. Next, there is a need to develop
imbalance in the screening of men and women appropriate training programs to prepare health-
(37.6% female), although rates of ACS are similar care workers to effectively screen for depression
between the sexes.94 Authors did not address these and anxiety in people with ACS and understand
differences in their reports except for where there the feasibility of having to complete these tasks.
was intended recruitment imbalance, for example, The wide variation in practice in this area could be
where all male26 or all female43,51 samples were due due to a workforce that does not have the capacity
to study inclusion criteria. Recent research has noted to complete this clinical task. Implementation of
a significant under-diagnosis of MI in women (11% patient-centered care in guidelines may be the first
to 22%) compared to men (19% to 21%),95 and step to address this.

Strengths and limitations of this review population who are unlikely to receive help for a
Whilst the strength of scoping reviews is constrained treatable condition if screening does not occur. Fur-
by lack of critical appraisal, a key strength of this ther research is required to understand how acute
review is the rigor of the methods used, including the cardiac services could be prepared to address the
inclusion of independent investigators. General lim- intersection with mental health services and to pro-
itations include a female participant minority, sub- vide treatment for depression and anxiety with
stantial heterogeneity in the use of screening tools and evidence-based psychosocial interventions.
cut-off criteria across included studies, and varying
times of when screening took place during the acute Acknowledgments
care stay. There is the presence of bias from consider- Dr Constance Kourbelis of the Caring Futures Insti-
ing only studies in the English language due to budget tute, Flinders University, Adelaide, Australia, for her
and time restraints, and not having access to trans- assistance with study selection and critical appraisal.
lators. However, within the previous few decades,
English has become the dominant language of science, Funding
with more than 90% of the indexed scientific articles
in the natural sciences published in this language.100 This work is supported by a Flinders University
The questions of what the appropriate times and School of Nursing and Midwifery, and University
locations are to screen for depression and anxiety, of South Australia Collaboration Grant (2014).
and whether this can be done in a hospital setting so RAC is supported by a Heart Foundation Future
that an assessment is made, requires further investi- Leader Fellowship (App ID: 100847).
gation. The current review did not find any studies
References
using the Geriatric Depression Scale,101 although
1. Kumar A, Cannon CP. Acute coronary syndromes: diagnosis
older participants were included in almost all studies. andmanagement,partII.Mayo ClinProc2009;84(11):1021–36.
Due to the higher proportion of older people 2. Hiriscau EI, Bodolea C. The role of depression and anxiety
experiencing depression,102 this is another limitation in frail patients with heart failure. Diseases 2019;7(2):45.
of this current review and may further impair the 3. Myers V, Gerber Y, Benyamini Y, Goldbourt U, Drory Y. Post-
generalizability of findings. myocardial infarction depression: increased hospital
admissions and reduced adoption of secondary preven-
Conclusion tion measures–a longitudinal study. J Psychosom Res
2012;72(1):5–10.
Depression and anxiety disorders, and ACS, are com-
4. Lavoie KL, Paine NJ, Pelletier R, Arsenault A, Diodati JG,
mon comorbidities, and clinical practice guidelines
Campbell TS, et al. Relationship between antidepressant
have previously recommended routine screening for therapy and risk for cardiovascular events in patients with
depression and anxiety following a cardiac event. This and without cardiovascular disease. Health Psychol
review identified 47 primary research studies, using a 2018;37(11):989–99.
total of 25 different tools, to screen for anxiety and/or 5. Joynt KE, Whellan DJ, O’Connor CM. Depression and car-
depression in ACS, and seven clinical practice guide- diovascular disease: mechanisms of interaction. Biol Psy-
lines. A lack of consistency in how depression and chiatry 2003;54(3):248–61.
anxiety screening tools were integrated into cardiac 6. Chung ML, Lennie TA, Mudd-Martin G, Dunbar SB, Pressler
models of care and clinical pathways was found. Only SJ, Moser DK. Depressive symptoms in patients with heart
half of ACS guidelines found for the period of this failure negatively affect family caregiver outcomes and
quality of life. Eur J Cardiovasc Nurs 2016;15(1):30–8.
review recommend screening for depression and/or
7. Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N,
anxiety. The implementation of patient-centered
Kaufmann PG, Lesperance F, et al. Depression and coronary
guidelines addressing anxiety and depression care in heart disease: recommendations for screening, referral,
ACS may be the first step to addressing where and and treatment: a science advisory from the American Heart
how screening takes place, and at what point this Association Prevention Committee of the Council on Car-
occurs in the patient’s treatment. diovascular Nursing, Council on Clinical Cardiology, Coun-
cil on Epidemiology and Prevention, and Interdisciplinary
Recommendations for research Council on Quality of Care and Outcomes Research:
Evidence-based practice gaps exist in the screening endorsed by the American Psychiatric Association. Circu-
for anxiety and/or depression for a vulnerable lation 2008;118(17):1768–75.

8. Post-Myocardial Infarction Depression Clinical Practice ScR): checklist and explanation. The PRISMA-ScR state-
Guideline Panel. AAFP guideline for the detection and ment. Ann Intern Med 2018;169(7):467–73.
management of post-myocardial infarction depression. 22. AbuRuz ME, Alaloul F, Al-Dweik G. Depressive symptoms
Ann Fam Med 2009;7(1):71–9. are associated with in-hospital complications following
9. Herridge M, Stimler C, Southard D, King ML; AACVPR Task acute myocardial infarction. Appl Nurs Res 2018;39:65–70.
Force. Depression screening in cardiac rehabilitation 23. Afridi MI, Habib S, Lal C, Khan AUR, Afaq SM, Tariq QD.
AACVPR position statement. J Cardiopulm Rehabil Frequency of depression in patients undergoing coronary
2005;25(1):11–3. artery bypass grafting surgery (CABGS), before the surgery,
10. Aroney CN, Aylward P, Kelly A-M, Chew DPB, Clune E; Acute at discharge and at six months Follow-up. J Liaquat Univ
Coronary Syndrome Guidelines Working Group. Guidelines Med Health Sci 2016;15(3):110–5.
for the management of acute coronary syndromes 2006. 24. Alexandri A, Georgiadi E, Mattheou P, Polikandrioti M.
Med J Aust 2006;184(S8):S1–32. Factors associated with anxiety and depression in hospi-
11. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a talized patients with first episode of acute myocardial
brief depression severity measure. J Gen Intern Med infarction. Arch Med Sci Atheroscler Dis 2017;2:e90–9.
2001;16(9):606–13. 25. Alvi HN, Ahmad S. Association between depression and
12. Atherton JJ, Sindone A, De Pasquale CG, Driscoll A, Mac- cardiovascular risk factors in patients of acute coronary
Donald PS, Hopper I, et al. National Heart Foundation of syndrome. Pak J Med Sci 2016;10(2):617–9.
Australia and Cardiac Society of Australia and New Zea- 26. Chaudhury S, Srivastava K. Relation of depression, anxiety,
land: Australian clinical guidelines for the management of and quality of life with outcome after percutaneous trans-
heart failure 2018. Med J Aust 2018;209(8):363–9. luminal coronary angioplasty. ScientificWorldJournal
13. Chew DP, Scott IA, Cullen L, French JK, Briffa TG, Tideman (6):2013:465979.
PA, et al. National Heart Foundation of Australia and 27. Demircelik MB, Cakmak M, Nazli Y, Sentepe E, Yigit D, Keklik
Cardiac Society of Australia and New Zealand: Australian M, et al. Effects of multimedia nursing education on
clinical guidelines for the management of acute coronary disease-related depression and anxiety in patients staying
syndromes 2016. Heart Lung Circ 2016;25(9):895–951. in a coronary intensive care unit. Appl Nurs Res
14. Keshavarz H, Fitzpatrick-Lewis D, Streiner DL, Maureen R, 2016;29(1):5–8.
Ali U, Shannon HS, et al. Screening for depression: a 28. Doering LV, Chen B, McGuire A, Bodan RC, Irwin MR.
systematic review and meta-analysis. CMAJ Open Persistent depressive symptoms and pain after cardiac
2013;1(4):E159–67. surgery. Psychosom Med 2014;76(6):437–44.
15. American Psychiatric Association. Diagnostic and statistical 29. Fattah K, Zulfiqar F, Hafiz S, Hafizullah M, Gul AM. Effect of
manual of mental disorders (DSM-5). 5th ed. Washington short term psychotherapy on depression in post myocar-
D.C.: American Psychiatric Association; 2013. dial infarction patients. Pak Heart J 2016;49(1):24–8.
16. Gilbody S, Richards D, Brealey S, Hewitt C. Screening for 30. Felice F, Di Stefano R, Pini S, Mazzotta G, Bovenzi FM,
depression in medical settings with the Patient Health Bertoli D, et al. Influence of depression and anxiety on
Questionnaire (PHQ): a diagnostic meta-analysis. J Gen circulating endothelial progenitor cells in patients with
Intern Med 2007;22(11):1596–602. acute coronary syndromes. Hum Psychopharmacol
17. Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House 2015;30(3):183–8.
A. The Hospital Anxiety and Depression Scale: a diagnostic 31. Georgousopoulou EN, Kastorini CM, Milionis HJ, Ntziou E,
meta-analysis of case-finding ability. J Psychosom Res Kostapanos MS, Nikolaou V, et al. Association between
2010;69(4):371–8. Mediterranean diet and non-fatal cardiovascular events, in
18. Stone JA, Cyr C, Friesen M, Kennedy-Symonds H, Stene R, the context of anxiety and depression disorders: a case/
Smilovitch M, et al. Canadian guidelines for cardiac reha- case-control study. Hellenic J Cardiol 2014;55(1):24–31.
bilitation and atherosclerotic heart disease prevention: a 32. Giammanco MD, Gitto L. Coping, uncertainty and health-
summary. Can J Cardiol 2001;17(Suppl B):3B–30B. related quality of life as determinants of anxiety and
19. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, depression on a sample of hospitalized cardiac patients
Soares CB. Guidance for conducting systematic scoping in southern Italy. Qual Life Res 2016;25(11):2941–56.
reviews. Int J Evid Based Healthc 2015;13(3):141–6. 33. Hoseini S, Soltani F, Babaee Beygi M, Zarifsanaee N. The
20. Franzon J, Haren MT, Kourbelis C, Marin T, Newman P, Jones effect of educational audiotape programme on anxiety
M, et al. Recommendations and practices for the screening and depression in patients undergoing coronary artery
of depression and anxiety in acute coronary syndrome: a bypass graft. J Clin Nurs 2013;22(11–12):1613–9.
scoping review protocol. JBI Database System Rev Imple- 34. Hosseini SH, Ghaemian A, Mehdizadeh E, Ashraf H. Levels
ment Rep 2018;16(7):1503–10. of anxiety and depression as predictors of mortality fol-
21. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac lowing myocardial infarction: a 5-year follow-up. Cardiol J
D, et al. PRISMA extension for scoping reviews (PRISMA- 2014;21(4):370–7.

35. Keegan C, Conroy R, Doyle F. Longitudinal modelling of 48. Patron E, Benvenuti SM, Zanatta P, Polesel E, Palomba D.
theory-based depressive vulnerabilities, depression trajec- Preexisting depressive symptoms are associated with
tories and poor outcomes post-ACS. J Affect Disord long-term cognitive decline in patients after cardiac sur-
2016;191:41–8. gery. Gen Hosp Psychiatry 2013;35(5):472–9.
36. Kroemeke A. Depressive symptom trajectories over a 6- 49. Pini S, Gesi C, Abelli M, Cardini A, Lari L, Felice F, et al.
year period following myocardial infarction: predictive Clinical correlates of complicated grief among individuals
function of cognitive appraisal and coping. J Behav Med with acute coronary syndromes. Neuropsych Dis Treat
2016;39(2):181–91. 2015;11(1):2583–9.
37. Maqsood S, Jehangiri AUR, Khan MN, Hayat U, Ajmal S, 50. Roest AM, Wardenaar KJ, de Jonge P. Symptom and course
Mushtaq M, et al. Depression In myocardial infarction heterogeneity of depressive symptoms and prognosis
patients at Ayub teaching hospital Abbottabad. J Ayub following myocardial infarction. J Health Psychol
Med Coll Abbottabad 2017;29(4):641–4. 2016;35(5):413–22.
38. Marchesi C, Ossola P, Scagnelli F, Paglia F, Aprile S, Monici A, 51. Sanner JE, Frazier L, Udtha M. Self-reported depressive
et al. Type D personality in never-depressed patients and symptoms in women hospitalized for acute coronary
the development of major and minor depression after syndrome. J Psychiatr Ment Health 2013;20(10):913–20.
acute coronary syndrome. J Affect Disord 2014;155(1): 52. Sararoudi RB, Motmaen M, Maracy MR, Pishghadam E,
194–9. Kheirabadi GR. Efficacy of illness perception focused inter-
39. McGuire AW, Eastwood J-A, Macabasco-O’Connell A, Hays vention on quality of life, anxiety, and depression in
RD, Doering LV. Depression screening: utility of the Patient patients with myocardial infarction. J Res Med Sci
Health Questionnaire in patients with acute coronary 2016;21(1):125.
syndrome. Am J Crit Care 2013;22(1):12–20. 53. Sertoz OO, Aydemir O, Gulpek D, Elbi H, Ozenli Y, Yilmaz A,
40. Mendonca da Cunha DM, Dos Anjos TS, Franca Lisboa Gois et al. The impact of physical and psychological comorbid
C, Tavares de Mattos MC, Vale Carvalho L, de Carvalho J, conditions on the quality of life of patients with acute
et al. Depressive symptoms in patients with coronary myocardial infarction: a multi-center, cross-sectional
artery disease. Invest Educ Enferm 2016;34(2):323–8. observational study from Turkey. Int J Psychiatry Med
41. Meneghetti CC, Guidolin BL, Zimmermann PR, Sfoggia A. 2013;45(2):97–109.
Screening for symptoms of anxiety and depression in patients 54. Shruthi DR, Kumar SS, Desai N, Raman R, Rao TSS. Psychi-
admitted to a university hospital with acute coronary syn- atric comorbidities in acute coronary syndromes: six-
drome. Trends Psychiatry Psychother 2017;39(1):12–8. month follow-up study. Indian J Psychiatry 2018;60(1):
42. Meyer T, Hussein S, Lange HW, Herrmann-Lingen C. Tran- 60–4.
sient impact of baseline depression on mortality in 55. Smolderen KG, Strait KM, Dreyer RP, D’Onofrio G, Zhou S,
patients with stable coronary heart disease during long- Lichtman JH, et al. Depressive symptoms in younger
term follow-up. Clin Res Cardiol 2014;103(5):389–95. women and men with acute myocardial infarction: insights
43. Murphy B, Rogerson M, Worcester M, Elliott P, Higgins R, Le from the VIRGO Study. Am Heart J 2015;4(4):15.
Grande M, et al. Predicting mortality 12 years after an acute 56. Smolderen KG, Buchanan DM, Gosch K, Whooley M,
cardiac event. Comparison between inhospital and 2- Chan PS, Vaccarino V, et al. Depression treatment and
month assessment of depressive symptoms in women. J 1-year mortality after acute myocardial infarction
Cardiopulm Rehabil Prev 2013;33(3):160–7. insights from the TRIUMPH registry (Translational
44. Murphy B, Ludeman D, Elliott P, Judd F, Humphreys J, Research Investigating Underlying Disparities in Acute
Edington J, et al. Red flags for persistent or worsening Myocardial Infarction Patients’ Health Status). Circulation
anxiety and depression after an acute cardiac event: a 6- 2017;135(18):1681–9.
month longitudinal study in regional and rural Australia. 57. Su S-F, Chang M-Y, He C-P. Social support, unstable angina,
Eur J Prev Cardiol 2014;21(9):1079–89. and stroke as predictors of depression in patients with
45. Olsen SJ, Schirmer H, Wilsgaard T, Bonaa KH, Hanssen TA. coronary heart disease. J Cardiovasc Nurs 2018;33(2):
Cardiac rehabilitation and symptoms of anxiety and 179–86.
depression after percutaneous coronary intervention. 58. Tatishvili S, Sinitsa M, Jorbendaze R, Kavtaradze G. Factors
Eur J Prev Cardiol 2018;25(10):1017–25. associated with depressive episode in patients hospital-
46. Ossola P, Paglia F, Pelosi A, De Panfilis C, Conte G, Tonna M, et al. ized with actute coronary events. Georgian Med News
Risk factors for incident depression in patients at first acute (258):2016:23–7.
coronary syndrome. Psychiatry Res 2015;228(3):448–53. 59. van Montfort E, Denollet J, Vermunt JK, Widdershoven J,
47. Parker GB, Cvejic E, Vollmer-Conna U, McCraw S, Granville Kupper N. The tense, the hostile and the distressed:
Smith I, Walsh WF. Depression and poor outcome after an multidimensional psychosocial risk profiles based on the
acute coronary event: clarification of risk periods and ESC interview in coronary artery disease patients-The
mechanisms. Aust N Z J Psychiatry 2018;53(2):148–57. THORESCI study. Gen Hosp Psychiatry 2017;47(1):103–11.

60. Vilchinsky N, Reges O, Leibowitz M, Khaskia A, Mosseri M, 74. Parker G, Hilton T, Bains J, Hadzi-Pavlovic D. Cognitive-
Kark JD. Symptoms of depression and anxiety as barriers to based measures screening for depression in the medically
participation in cardiac rehabilitation programs among ill: the DMI-10 and the DMI-18. Acta Psychiatr Scand
Arab and Jewish patients in Israel. J Cardiopulm Rehabil 2002;105(6):419–26.
Prev 2018;38(3):163–9. 75. Hamilton M. Development of a rating scale for primary
61. Vollmer-Conna U, Cvejic E, Granville Smith I, Hadzi-Pavlovic depressive illness. Br J Soc Clin Psychol 1967;6(4):278–96.
D, Parker G. Characterising acute coronary syndrome- 76. Sheehan DV, Lecrubier Y, Harnett Sheehan K, Janavs J,
associated depression: let the data speak. Brain Behav Weiller E, Keskiner A, et al. The validity of the Mini Interna-
Immun 2015;48(1):19–28. tional Neuropsychiatric Interview (MINI) according to the
62. Whang W, Davidson KW, Palmeri NO, Bhatt AB, Peacock J, SCID-P and its reliability. Eur Psychiatry 1997;12(5):232–41.
Chaplin WF, et al. Relations among depressive symptoms, 77. Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV
electrocardiographic hypertrophy, and cardiac events in 3rd, Hahn SR, et al. Utility of a new procedure for diagnos-
non-ST elevation acute coronary syndrome patients. Eur ing mental disorders in primary care. The PRIME-MD 1000
Heart J Acute Cardiovasc Care 2016;5(5):455–60. study. JAMA 1994;272(22):1749–56.
63. Wilkowska A, Rynkiewicz A, Wdowczyk J, Landowski J. 78. Zung W. A self-rating depression scale. JAMA Psychiatry
Morning and afternoon serum cortisol level in patients 1965;12(1):63–70.
with post-myocardial infarction depression. Cardiol J 79. Spitzer R, Williams J, Gibbon M, First M. Structured clinical
2017;26(5):550–4. interview for DSM-IV Axis I disorders (SCID-I). I: History,
64. Yammine L, Frazier L, Padhye NS, Burg MM, Meininger JC. rationale, and description. Arch Gen Psychiatry 1992;49(8):
Severe depressive symptoms are associated with elevated 624–9.
endothelin-1 in younger patients with acute coronary 80. Khalil AA, Hall LA, Moser DK, Lennie TA, Frazier SK. The
syndrome. J Psychosom Res 2014;77(5):430–4. psychometric properties of the Brief Symptom Inventory
65. Yu HY, Park Y-S, Son Y-J. Combined effect of left ventricular depression and anxiety subscales in patients with heart
ejection fraction and post-cardiac depressive symptoms failure and with or without renal dysfunction. Arch Psy-
on major adverse cardiac events after successful primary chiatr Nurs 2011;25(6):419–29.
percutaneous coronary intervention: a 12-month follow- 81. Costello CG, Comrey AL. Scales for measuring depression
up. Eur J Cardiovasc Nurs 2017;16(1):37–45. and anxiety. J Psychol 1967;66(2):303–13.
66. Yüksel V, Gorgulu Y, Cinar RK, Huseyin S, Sonmez MB, 82. Hamilton M. The assessment of anxiety states by rating. Br
Canbaz S. Impact of experiencing acute coronary syn- J Clin Psychol 1959;32(1):50–5.
drome prior to open heart surgery on psychiatric status. 83. Zung WW. A rating instrument for anxiety disorders.
Braz J Cardiovasc Surg 2016;31(4):281–6. Psychosomatics 1971;12(6):371–9.
67. Zhang P. Study of anxiety/depression in patients with 84. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs
coronary heart disease after percutaneous coronary inter- GA. Manual for the state-trait anxiety inventory. Palo Alto,
vention. Cell Biochem Biophys 2015;72(2):503–7. CA: Consulting Psychologists Press; 1983.
68. Zuidersma M, Conradi HJ, van Melle JP, Ormel J, de 85. Fountoulakis KN, Papadopoulou M, Kleanthous S, Papado-
Jonge P. Self-reported depressive symptoms, diagnosed poulou A, Bizeli V, Nimatoudis I, et al. Reliability and
clinical depression and cardiac morbidity and mortality psychometric properties of the Greek translation of the
after myocardial infarction. Int J Cardiol 2013;167(6): State-Trait Anxiety Inventory form Y: preliminary data. Ann
2775–80. Gen Psychiatry 2006;5(1):2.
69. Beck AT, Steer RA, Carbin MG. Psychometric properties of 86. Brooks R. EuroQol: the current state of play. Health Policy
the Beck Depression Inventory: twenty-five years of evalu- 1996;37(1):53–72.
ation. Clin Psychol Rev 1988;8(1):77–100. 87. Sharif F, Shoul A, Janati M, Kojuri J, Zare N. The effect of
70. Beck AT, Steer RA, Brown GK. Manual for the Beck Depres- cardiac rehabilitation on anxiety and depression in
sion Inventory-II, San Antonio. TX: Psychological Corpora- patients undergoing cardiac bypass graft surgery in Iran.
tion; 1996. BMC Cardiovasc Disord 2012;12(1):40.
71. Scheinthal SM, Steer RA, Giffin L, Beck AT. Evaluating 88. Fredericks S, Guruge S, Sidani S, Wan T. Postoperative
geriatric medical outpatients with the Beck Depression patient education: a systematic review. Clin Nurs Res
Inventory-Fastscreen for medical patients. Aging Ment 2010;19(2):144–64.
Health 2001;5(2):143–8. 89. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C,
72. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: Catapano AL, et al. 2016 European guidelines on cardio-
an introductory report. Psychol Med 1983;13(3):595–605. vascular disease prevention in clinical practice: the sixth
73. Radloff LS. The CES-D Scale: a self-report depression scale joint task force of the European Society of Cardiology and
for research in the general population. Appl Psychol Meas other societies on cardiovascular disease prevention in
1977;1(3):385–401. clinical practice (constituted by representatives of 10

societies and by invited experts) developed with the 96. Dougherty AH. Gender balance in cardiovascular research:
special contribution of the European Association for Car- importance to women’s health. Tex Heart Inst J
diovascular Prevention & Rehabilitation (EACPR). Eur Heart 2011;38(2):148–50.
J 2016;37(29):2315–81. 97. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci
90. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, C, Bueno H, et al. 2017 ESC Guidelines for the management
Ganiats TG, Holmes DR Jr et al. 2014 ACC/AHA guideline of acute myocardial infarction in patients presenting with
for the management of patients with non-ST-elevation ST-segment elevation. Kardiol Pol 2018;76(2):229–313.
acute coronary syndromes: a report of the American 98. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M,
College of Cardiology/American Heart Association Task Andreotti F, et al. 2015 ESC Guidelines for the management
Force on practice guidelines. J Am Coll Cardiol of acute coronary syndromes in patients presenting with-
2014;64(24):e139–228. out persistent ST-segment elevation: task force for the
91. Woodruffe S, Neubeck L, Clark RA, Gray K, Ferry C, Finan J, management of acute coronary syndromes in patients
et al. Australian Cardiovascular Health and Rehabilitation presenting without persistent ST-segment elevation of
Association (ACRA) core components of cardiovascular the European Society of Cardiology (ESC). Eur Heart J
disease secondary prevention and cardiac rehabilitation 2016;37(3):267–315.
2014. Heart Lung Circ 2015;24(5):430–41. 99. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P,
92. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung Foody JM, et al. Core components of cardiac rehabilita-
MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the tion/secondary prevention programs: 2007 update: a sci-
management of ST-elevation myocardial infarction: a entific statement from the American Heart Association
report of the American College of Cardiology Founda- Exercise, Cardiac Rehabilitation, and Prevention Commit-
tion/American Heart Association Task Force on practice tee, the Council on Clinical Cardiology; the Councils on
guidelines. J Am Coll Cardiol 2013;61(4):e78–140. Cardiovascular Nursing, Epidemiology and Prevention, and
93. Rancans E, Trapencieris M, Ivanovs R, Vrublevska J. Validity Nutrition, Physical Activity, and Metabolism; and the Amer-
of the PHQ-9 and PHQ-2 to screen for depression in ican Association of Cardiovascular and Pulmonary Reha-
nationwide primary care population in Latvia. Ann Gen bilitation. Circulation 2007;115(20):2675–82.
Psychiatry 2018;17(1):33. 100. Di Bitetti MS, Ferreras JA. Publish (in English) or perish: the
94. McSweeney JC, Rosenfeld AG, Abel WM, Braun LT, Burke LE, effect on citation rate of using languages other than
Daugherty SL, et al. Preventing and experiencing ischemic English in scientific publications. Ambio 2017;46(1):121–7.
heart disease as a woman: state of the science: a scientific 101. Mitchell AJ, Bird V, Rizzo M, Meader N. Which version of the
statement from the American Heart Association. Circula- geriatric depression scale is most useful in medical settings
tion 2016;133(13):1302–31. and nursing homes? Diagnostic validity meta-analysis. Am
95. Shah AS, Griffiths M, Lee KK, McAllister DA, Hunter AL, Ferry J Geriatr Psychiatry 2010;18(12):1066–77.
AV, et al. High sensitivity cardiac troponin and the under- 102. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epi-
diagnosis of myocardial infarction in women: prospective demiology of coronary heart disease and acute coronary
cohort study. BMJ 2015;350(4):g7873. syndrome. Ann Transl Med 2016;4(13):256.

Appendix I: Search strategy
Database Records retrieved
Ovid MEDLINE 3709
Ovid PsycINFO 1857
EBSCO CINAHL 1289
CENTRAL (Cochrane) 1136
Scopus 3269
Web of Science 3835
Total 15,095
Database(s): Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid
MEDLINE(R) Daily, Ovid MEDLINE and Versions (R) Search Strategy:
Search date: 1 June 2019
Records
# Searches retrieved
1 Acute Coronary Syndrome/ 12,594
2 exp Myocardial Infarction/ 164,010
3 Myocardial Ischemia/ 36,518
4 exp angina pectoris/ 42,173
5 exp coronary disease/ 204,979
6 exp Myocardial Revascularization/ 87,433
7 exp Percutaneous Coronary Intervention/ 46,760
8 exp Angioplasty/ 59,029
9 exp Stents/ 68,380

10 ((myocardial or cardiac or heart) adj2 (infarct or isch?emi )).tw,kf. 239,757
11 (AMI or MI).tw,kf. 56,513
12 (STEMI or NSTEMI).tw,kf. 9777

13 (ST adj2 (elevat or depress )).tw,kf. 29,402

14 (heart adj2 attack ).tw,kf. 5170

15 (coronary adj2 (syndrome or disease or event or occlusion or stenos or thrombo )).tw,kf. 183,994
16 (ACS or STEACS or NSTEACS or CAD or CHD).tw,kf. 73,072

17 (Myocardial adj2 Revasculari ).tw,kf. 5387

18 coronary artery bypass .tw,kf. 37,557
19 CABG.tw,kf. 16,342

20 aortocoronary bypass .tw,kf. 2429

21 angioplast .tw,kf. 42,071

22 ((coronary or arterial) adj4 dilat ).tw,kf. 5155

(Continued)
Records
23 PTCA.tw,kf. 6427

24 (percutaneous coronary adj2 (interven or revascular )).tw,kf. 29,090
25 PCI.tw,kf. 21,532

26 (endoluminal adj2 repair ).tw,kf. 268
27 EVAR.tw,kf. 3351

28 stent .tw,kf. 89,298
29 or/1-28 688,636
30 mood disorders/ or depression/ or exp depressive disorder/ or bipolar disorder/ 229,418
31 exp anxiety/ or exp anxiety disorders/ 140,857

32 (depression or depressive or dysthymi or bipolar).tw,kf. 375,920
33 (anxiety or GAD).tw,kf. 167,573

34 (mood disorder or affective disorder or dysregulation disorder ).tw,kf. 304,38
35 or/30-34 576,667
36 critical care/ or intensive care units/ or coronary care units/ or exp hospitalization/ or inpatients/ 298,363

37 (hospitali or inpatient or in-patient ).tw,kf. 1,726,331

38 (coronary or cardi or acute care or critical care).tw,kf. 1,334,109
39 or/36-38 2,949,696
40 ‘‘Surveys and Questionnaires’’/ or Health Care Surveys/ or Patient Reported Outcome Measures/ or Self Report/ or 443,447
Patient Health Questionnaire/ or Behavioral Risk Factor Surveillance System/
41 (‘‘Beck Depression Inventory’’ or BDI or ‘‘Beck Anxiety Inventory’’ or BAI or ‘‘Beck Hopelessness Scale’’ or BHS or ‘‘Beck 70,339
Scale for Suicide Ideation’’ or BSS or ‘‘Center for Epidemiologic Studies Depression Scale’’ or CES-D or CESD-R or ‘‘Center for
Epidemiologic Studies Depression Scale Revised’’ or CESD-R or ‘‘Hamilton Rating Scale for Depression’’ or HRSD or HAM-D
or ‘‘Hamilton Depression Rating Scale’’ or HDRS or ‘‘Hospital Anxiety and Depression Scale’’ or HADS or ‘‘Major Depression
Inventory’’ or MDI or ‘‘patient health questionnaire 9’’ or PHQ-9 or ‘‘Patient Health Questionnaire 2’’ or PHQ-2 or
‘‘Symptom Checklist 90’’ or SCL-90 or WHO-5 or ‘‘Depression Anxiety Stress Scales’’ or DASS-21 or ‘‘Generalized Anxiety
Disorder questionnaire’’ or GADQ or ‘‘Generalized Anxiety Disorder 7’’ or GAD-7 or ‘‘Hamilton Anxiety Rating Scale’’ or
HARS).tw,kf.
42 (screen or questionnaire or evaluation or diagnost or assessment or measure or test? or scale or inventory or 6,720,588
inventories).tw,kf.
43 or/40-42 6,859,362
44 and/29,35,39,43 8651
45 limit 44 to (English language and yr¼‘‘2005 -Current’’) 3890
46 exp child/ not (exp child/ and adult/) 1,158,884
47 adolescents/ not (adolescents/ and adults/) 613,582
48 (child or infant or teen or youth or adolescen or p?ediatric).ti. 1,119,387
49 exp animals/ not (exp animals/ and humans/) 4,470,062

(Continued)
Records
50 (commentary or editorial or letter or news or newspaper article).pt. 1,656,907
51 or/46-50 7,770,098
52 45 not 51 3709
Database(s): PsycINFO Search Strategy

Records
1 exp heart disorders/ 13,314
2 angina pectoris/ 285
3 heart surgery/ 1436

4 ((myocardial or cardiac or heart) adj2 (infarct or isch?emi )).tw. 5422
5 (AMI or MI).tw. 5521
6 (STEMI or NSTEMI).tw. 39

7 (ST adj2 (elevat or depress )).tw. 175

8 (heart adj2 attack ).tw. 1011

9 (coronary adj2 (syndrome or disease or event or occlusion or stenos or thrombo )).tw. 6865
10 (ACS or STEACS or NSTEACS or CAD or CHD).tw. 4269

11 (Myocardial adj2 Revasculari ).tw. 26

12 coronary artery bypass .tw. 827
13 CABG.tw. 418

14 aortocoronary bypass .tw. 8

15 angioplast .tw. 337

16 ((coronary or arterial) adj4 dilat ).tw. 57
17 PTCA.tw. 52

18 (percutaneous coronary adj2 (interven or revascular )).mp. [mp¼title, abstract, heading word, table of contents, key 196
concepts, original title, tests & measures]
19 PCI.tw. 537

20 (endoluminal adj2 repair ).tw. 0
21 EVAR.tw. 18

22 stent .tw. 524
23 or/1-22 27,102
24 exp affective disorders/ 150,641
25 exp anxiety disorders/ 76,634

(Continued)
Records
26 anxiety/ 55,870
27 ‘‘depression (emotion)’’/ 24,360

28 (depression or depressive or dysthymi or bipolar).tw. 284,292
29 (anxiety or GAD).tw. 179,419

30 (mood disorder or affective disorder or dysregulation disorder ).tw. 31,741
31 or/24-30 448,783
32 intensive care/ 3756
33 exp Hospitalized Patients/ or exp Hospitalization/ 32,334

34 (hospitali or inpatient or in-patient ).tw. 181,154

35 (coronary or cardi or acute care or critical care).tw. 61,055
36 or/32-35 243,475
37 surveys/ 7554
38 exp Self-Report/ 15,416
39 questionnaires/ or general health questionnaire/ 17,440

40 (‘‘Beck Depression Inventory’’ or BDI or ‘‘Beck Anxiety Inventory’’ or BAI or ‘‘Beck Hopelessness Scale’’ or BHS or ‘‘Beck 40,602
Scale for Suicide Ideation’’ or BSS or ‘‘Center for Epidemiologic Studies Depression Scale’’ or CES-D or CESD-R or ‘‘Center for
Epidemiologic Studies Depression Scale Revised’’ or CESD-R or ‘‘Hamilton Rating Scale for Depression’’ or HRSD or HAM-D
or ‘‘Hamilton Depression Rating Scale’’ or HDRS or ‘‘Hospital Anxiety and Depression Scale’’ or HADS or ‘‘Major Depression
Inventory’’ or MDI or ‘‘patient health questionnaire 9’’ or PHQ-9 or ‘‘Patient Health Questionnaire 2’’ or PHQ-2 or
‘‘Symptom Checklist 90’’ or SCL-90 or WHO-5 or ‘‘Depression Anxiety Stress Scales’’ or DASS-21 or ‘‘Generalized Anxiety
Disorder questionnaire’’ or GADQ or ‘‘Generalized Anxiety Disorder 7’’ or GAD-7 or ‘‘Hamilton Anxiety Rating Scale’’ or
HARS).tw.
41 (screen or questionnaire or evaluation or diagnost or assessment or measure or test? or scale or inventory or 1,690,833
inventories).tw.
42 or/37-41 1,700,624
43 and/23,31,36,42 2921
44 limit 43 to (english language and yr¼‘‘2005 -Current’’) 1891

45 (child or infant or teen or youth or adolescen or p?ediatric ).ti. 476,596
46 44 not 45 1857

CINAHL EBSCOhost
Records
# Query Limiters/Expanders Last run via retrieved
S45 S43 NOT S44 Search modes - Interface - EBSCOhost Research Databases 1289
Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S44 TI child OR infant OR teen OR youth OR adolescen Search modes - Interface - EBSCOhost Research Databases 253,137
OR pediatric OR paediatric Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S43 S24 AND S30 AND S37 AND S42 Limiters - Published Interface - EBSCOhost Research Databases 1309
Date: 20050101- Search Screen - Advanced Search
20181231; English Database - CINAHL
Language
Search modes -
Boolean/Phrase
S42 S38 OR S39 OR S40 OR S41 Search modes - Interface - EBSCOhost Research Databases 1,072,056
Database - CINAHL
S41 TI (screen OR questionnaire OR evaluation OR diag- Search modes - Interface - EBSCOhost Research Databases 793,103
nost OR assessment OR measure OR test OR tests OR Boolean/Phrase Search Screen - Advanced Search
scale OR inventory OR inventories) OR AB (screen OR Database - CINAHL
questionnaire OR evaluation OR diagnost OR
assessment OR measure OR test OR tests OR scale OR
inventory OR inventories)
S40 TI (‘‘Beck Depression Inventory’’ OR BDI OR ‘‘Beck Search modes - Interface - EBSCOhost Research Databases 328,204
Anxiety Inventory’’ OR BAI OR ‘‘Beck Hopelessness Boolean/Phrase Search Screen - Advanced Search
Scale’’ OR BHS OR ‘‘Beck Scale for Suicide Ideation’’ OR Database - CINAHL
BSS OR ‘‘Center for Epidemiologic Studies Depression
Scale’’ OR CES-D OR CESD-R OR ‘‘Center for Epidemiologic
Studies Depression Scale Revised’’ OR CESD-R OR ‘‘Hamil-
ton Rating Scale for Depression’’ OR HRSD OR HAM-D OR
‘‘Hamilton Depression Rating Scale’’ OR HDRS OR ‘‘Hospi-
tal Anxiety and Depression Scale’’ OR HADS OR ‘‘Major
Depression Inventory’’ OR MDI OR ‘‘patient health
questionnaire 9’’ OR PHQ-9 OR ‘‘Patient Health Question-
naire 2’’ OR PHQ-2 OR ‘‘Symptom Checklist 90’’ OR SCL-
90 OR WHO-5 OR ‘‘Depression Anxiety Stress Scales’’ OR
DASS-21 OR ‘‘Generalized Anxiety Disorder questionnaire’’
OR GADQ OR ‘‘Generalized Anxiety Disorder 7’’ OR GAD-7
OR ‘‘Hamilton Anxiety Rating Scale’’ OR HARS) OR AB
(‘‘Beck Depression Inventory’’ OR BDI OR ‘‘Beck Anxiety
Inventory’’ OR BAI OR ‘‘Beck Hopelessness Scale’’ OR
BHS OR ‘‘Beck Scale for Suicide Ideation’’ OR BSS OR
‘‘Center for Epidemiologic Studies Depression Scale’’ OR
CES-D OR CESD-R OR ‘‘Center for Epidemiologic Studies
Depression Scale Revised’’ OR CESD-R OR ‘‘Hamilton
Rating Scale for Depression’’ OR HRSD OR HAM-D OR
‘‘Hamilton Depression Rating Scale’’ OR HDRS OR ‘‘Hospi-
tal Anxiety and Depression Scale’’ OR HADS OR ‘‘Major
Depression Inventory’’ OR MDI OR ‘‘patient health
questionnaire 9’’ OR PHQ-9 OR ‘‘Patient Health Question-
naire 2’’ OR PHQ-2 OR ‘‘Symptom Checklist 90’’ OR SCL-
90 OR WHO-5 OR ‘‘Depression Anxiety Stress Scales’’ OR
DASS-21 OR ‘‘Generalized Anxiety Disorder questionnaire’’
OR GADQ OR ‘‘Generalized Anxiety Disorder 7’’ OR GAD-7
OR ‘‘Hamilton Anxiety Rating Scale’’ OR HARS)
S39 (MH ‘‘Self Report’’) OR (MH ‘‘Patient-Reported Out- Search modes - Interface - EBSCOhost Research Databases 44,541
comes’’) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S38 (MH ‘‘Surveysþ’’) OR (MH ‘‘Questionnaires’’) OR (MH Search modes - Interface - EBSCOhost Research Databases 336,712
‘‘Behavior Rating Scales’’) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL

(Continued)
Records
S37 S31 OR S32 OR S33 OR S34 OR S35 OR S36 Search modes - Interface - EBSCOhost Research Databases 957,718
Database - CINAHL
S36 TI (coronary OR cardi OR ‘‘acute care’’ OR ‘‘critical care’’) Search modes - Interface - EBSCOhost Research Databases 186,555
OR AB (coronary OR cardi OR ‘‘acute care’’ OR ‘‘critical Boolean/Phrase Search Screen - Advanced Search
care’’) Database - CINAHL
S35 TI (hospitali OR inpatient OR ‘‘in-patient ’’) OR AB Search modes - Interface - EBSCOhost Research Databases 830,313
(hospitali OR inpatient OR ‘‘in-patient ’’) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S34 (MH ‘‘Inpatients’’) Search modes - Interface - EBSCOhost Research Databases 66,254
Database - CINAHL
S33 (MH ‘‘Coronary Care Units’’) Search modes - Interface - EBSCOhost Research Databases 746
Database - CINAHL
S32 (MH ‘‘Intensive Care Units’’) Search modes - Interface - EBSCOhost Research Databases 21,766
Database - CINAHL
S31 (MH ‘‘Cardiovascular Care’’) OR (MH ‘‘Critical Care’’) Search modes - Interface - EBSCOhost Research Databases 14,951
Database - CINAHL
S30 S25 OR S26 OR S27 OR S28 OR S29 Search modes - Interface - EBSCOhost Research Databases 128,259
Database - CINAHL
S29 TI (‘‘mood disorder ’’ OR ‘‘affective disorder ’’ OR ‘‘dysre- Search modes - Interface - EBSCOhost Research Databases 3303
gulation disorder ’’) OR AB (‘‘mood disorder ’’ OR ‘‘affec- Boolean/Phrase Search Screen - Advanced Search
tive disorder ’’ OR ‘‘dysregulation disorder ’’) Database - CINAHL
S28 TI (anxiety OR GAD) OR AB (anxiety OR GAD) Search modes - Interface - EBSCOhost Research Databases 36,954
Database - CINAHL
S27 TI (depression OR depressive OR dysthymi OR bipolar) Search modes - Interface - EBSCOhost Research Databases 70,756
OR AB (depression OR depressive OR dysthymi OR Boolean/Phrase Search Screen - Advanced Search
bipolar) Database - CINAHL
S26 (MH ‘‘Anxiety’’) Search modes - Interface - EBSCOhost Research Databases 21,512
Database - CINAHL
S25 (MH ‘‘Affective Disorders’’) OR (MH ‘‘Depressionþ’’) OR Search modes - Interface - EBSCOhost Research Databases 78,554
(MH ‘‘Anxiety Disordersþ’’) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S24 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 Search modes - Interface - EBSCOhost Research Databases 93,236
OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 Boolean/Phrase Search Screen - Advanced Search
OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 Database - CINAHL
S23 TI stent OR AB stent Search modes - Interface - EBSCOhost Research Databases 10,716
Database - CINAHL
S22 TI EVAR OR AB EVAR Search modes - Interface - EBSCOhost Research Databases 288
Database - CINAHL
S21 TI endoluminal N2 repair OR AB endoluminal N2 repair Search modes - Interface - EBSCOhost Research Databases 30
Database - CINAHL
S20 TI PCI OR AB PCI Search modes - Interface - EBSCOhost Research Databases 2971
Database - CINAHL
S19 TI ((‘‘percutaneous coronary’’ N2 (interven OR Search modes - Interface - EBSCOhost Research Databases 5670
revascular))) OR AB ((‘‘percutaneous coronary’’ N2 (inter- Boolean/Phrase Search Screen - Advanced Search

ven OR revascular ))) Database - CINAHL

(Continued)
Records
S18 TI (((coronary OR arterial) N4 dilat)) OR AB (((coronary Search modes - Interface - EBSCOhost Research Databases 294
OR arterial) N4 dilat)) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S17 TI angioplast OR AB angioplast Search modes - Interface - EBSCOhost Research Databases 3281
Database - CINAHL
S16 TI ‘‘aortocoronary bypass’’ OR AB ‘‘aortocoronary Search modes - Interface - EBSCOhost Research Databases 46
bypass’’ Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S15 TI CABG OR AB CABG Search modes - Interface - EBSCOhost Research Databases 2292
Database - CINAHL
S14 TI ‘‘coronary artery bypass’’ OR AB ‘‘coronary artery Search modes - Interface - EBSCOhost Research Databases 5085
bypass’’ Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S13 TI Myocardial N2 Revasculari OR AB Myocardial N2 Search modes - Interface - EBSCOhost Research Databases 530
Revasculari Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S12 TI (ACS OR STEACS OR NSTEACS OR CAD OR CHD) OR AB Search modes - Interface - EBSCOhost Research Databases 10,014
(ACS OR STEACS OR NSTEACS OR CAD OR CHD) Boolean/Phrase Search Screen - Advanced Search
Database - CINAHL
S11 TI ((coronary N2 (syndrome OR disease OR event OR Search modes - Interface - EBSCOhost Research Databases 25,657
occlusion OR stenos OR thrombo))) OR AB ((coronary Boolean/Phrase Search Screen - Advanced Search
N2 (syndrome OR disease OR event OR occlusion OR Database - CINAHL
stenos OR thrombo)))
S10 TI (heart N2 attack) OR AB (heart N2 attack) Search modes - Interface - EBSCOhost Research Databases 2347
Database - CINAHL
S9 TI (STEMI OR NSTEMI) OR AB (STEMI OR NSTEMI) Search modes - Interface - EBSCOhost Research Databases 1596
Database - CINAHL
S8 TI (AMI OR MI) OR AB (AMI OR MI) Search modes - Interface - EBSCOhost Research Databases 7815
Database - CINAHL
S7 TI (((myocardial OR cardiac OR heart) N2 (infarct OR Search modes - Interface - EBSCOhost Research Databases 27,468
ischemi OR ischaemi))) OR AB (((myocardial OR cardiac Boolean/Phrase Search Screen - Advanced Search
OR heart) N2 (infarct OR ischemi OR ischaemi))) Database - CINAHL
S6 (MH ‘‘Angioplastyþ’’) Search modes - Interface - EBSCOhost Research Databases 8917
Database - CINAHL
S5 (MH ‘‘Myocardial Revascularizationþ’’) Search modes - Interface - EBSCOhost Research Databases 14,081
Database - CINAHL
S4 (MH ‘‘Coronary Diseaseþ’’) Search modes - Interface - EBSCOhost Research Databases 29,575
Database - CINAHL
S3 (MH ‘‘Angina Pectorisþ’’) Search modes - Interface - EBSCOhost Research Databases 4746
Database - CINAHL
S2 (MH ‘‘Myocardial Infarctionþ’’) Search modes - Interface - EBSCOhost Research Databases 26,162
Database - CINAHL
S1 (MH ‘‘Acute Coronary Syndrome’’) Search modes - Interface - EBSCOhost Research Databases 2829
Database - CINAHL

CENTRAL (Cochrane)
(((‘‘myocardial’’ OR ‘‘cardiac’’ OR ‘‘heart’’) NEAR/2 (‘‘infarct’’ OR ‘‘ischemi’’ OR ‘‘ischaemi’’)) OR
‘‘AMI’’ OR ‘‘MI’’ OR ‘‘STEMI’’ OR ‘‘NSTEMI’’ OR (‘‘ST’’ NEAR/2 (‘‘elevat’’ OR ‘‘depress’’)) OR
(‘‘heart’’ NEAR/2 ‘‘attack’’) OR (‘‘coronary’’ NEAR/2 (‘‘syndrome’’ OR ‘‘disease’’ OR ‘‘event’’
OR ‘‘occlusion’’ OR ‘‘stenos’’ OR ‘‘thrombo’’)) OR ‘‘ACS’’ OR ‘‘STEACS’’ OR ‘‘NSTEACS’’ OR
‘‘CAD’’ OR ‘‘CHD’’ OR (‘‘Myocardial’’ NEAR/2 ‘‘Revasculari’’) OR ‘‘coronary artery bypass’’ OR
‘‘CABG’’ OR ‘‘aortocoronary bypass’’ OR ‘‘angioplast’’ OR ((‘‘coronary’’ OR ‘‘arterial’’) NEAR/4
‘‘dilat’’) OR ‘‘PTCA’’ OR (‘‘percutaneous coronary’’ NEAR/2 (‘‘interven’’ OR ‘‘revascular’’)) OR
‘‘PCI’’ OR (‘‘endoluminal’’ NEAR/2 ‘‘repair’’)) AND (‘‘depression’’ OR ‘‘depressive’’ OR ‘‘dysthymi’’
OR ‘‘bipolar’’ OR ‘‘anxiety’’ OR ‘‘GAD’’ OR ‘‘mood disorder’’ OR ‘‘affective disorder’’ OR ‘‘dysregu-
lation disorder’’) AND (‘‘hospitali’’ OR ‘‘inpatient’’ OR ‘‘in-patient’’ OR ‘‘coronary’’ OR ‘‘cardi’’ OR
‘‘acute care’’ OR ‘‘critical care’’) AND (‘‘Beck Depression Inventory’’ OR ‘‘BDI’’ OR ‘‘Beck Anxiety
Inventory’’ OR ‘‘BAI’’ OR ‘‘Beck Hopelessness Scale’’ OR ‘‘BHS’’ OR ‘‘Beck Scale for Suicide Ideation’’
OR ‘‘BSS’’ OR ‘‘Center for Epidemiologic Studies Depression Scale’’ OR ‘‘CES-D’’ OR ‘‘CESD-R’’ OR
‘‘Center for Epidemiologic Studies Depression Scale Revised’’ OR ‘‘CESD-R’’ OR ‘‘Hamilton Rating Scale
for Depression’’ OR ‘‘HRSD’’ OR ‘‘HAM-D’’ OR ‘‘Hamilton Depression Rating Scale’’ OR ‘‘HDRS’’ OR
‘‘Hospital Anxiety and Depression Scale’’ OR ‘‘HADS’’ OR ‘‘Major Depression Inventory’’ OR ‘‘MDI’’ OR
‘‘patient health questionnaire 9’’ OR ‘‘PHQ-9’’ OR ‘‘Patient Health Questionnaire 2’’ OR ‘‘PHQ-2’’ OR
‘‘Symptom Checklist 90’’ OR ‘‘SCL-90’’ OR ‘‘WHO-5’’ OR ‘‘Depression Anxiety Stress Scales’’ OR ‘‘DASS-
21’’ OR ‘‘Generalized Anxiety Disorder questionnaire’’ OR ‘‘GADQ’’ OR ‘‘Generalized Anxiety Disorder
7’’ OR ‘‘GAD-7’’ OR ‘‘Hamilton Anxiety Rating Scale’’ OR ‘‘HARS’’ OR ‘‘screen’’ OR ‘‘questionnaire’’
OR ‘‘evaluation’’ OR ‘‘diagnost’’ OR ‘‘assessment’’ OR ‘‘measure’’ OR ‘‘test’’ OR ‘‘tests’’ OR ‘‘scale’’
OR ‘‘inventory’’ OR ‘‘inventories’’))
(n ¼ 1136)
Scopus
((TITLE-ABS(((myocardial OR cardiac OR heart) W/2 (infarct OR ischemi OR ischaemi)) OR AMI OR
MI OR STEMI OR NSTEMI OR (ST W/2 (elevat OR depress)) OR (heart W/2 attack) OR (coronary W/2
(syndrome OR disease OR event OR occlusion OR stenos OR thrombo)) OR ACS OR STEACS OR
NSTEACS OR CAD OR CHD OR (Myocardial W/2 Revasculari) OR ‘‘coronary artery bypass’’ OR
CABG OR ‘‘aortocoronary bypass’’ OR angioplast OR ((coronary OR arterial) N4 dilat) OR PTCA OR
(‘‘percutaneous coronary’’ W/2 (interven OR revascular)) OR PCI OR (endoluminal W/2 repair)) AND
TITLE-ABS(depression OR depressive OR dysthymi OR bipolar OR anxiety OR GAD OR ‘‘mood
disorder’’ OR ‘‘affective disorder’’ OR ‘‘dysregulation disorder’’) AND TITLE-ABS(hospitali OR
inpatient OR ‘‘in-patient’’ OR coronary OR cardi OR ‘‘acute care’’ OR ‘‘critical care’’) AND TITLE-
ABS(‘‘Beck Depression Inventory’’ OR BDI OR ‘‘Beck Anxiety Inventory’’ OR BAI OR ‘‘Beck Hope-
lessness Scale’’ OR BHS OR ‘‘Beck Scale for Suicide Ideation’’ OR BSS OR ‘‘Center for Epidemiologic
Studies Depression Scale’’ OR CES-D OR CESD-R OR ‘‘Center for Epidemiologic Studies Depression Scale
Revised’’ OR CESD-R OR ‘‘Hamilton Rating Scale for Depression’’ OR HRSD OR HAM-D OR ‘‘Hamilton
Depression Rating Scale’’ OR HDRS OR ‘‘Hospital Anxiety and Depression Scale’’ OR HADS OR ‘‘Major
Depression Inventory’’ OR MDI OR ‘‘patient health questionnaire 9’’ OR PHQ-9 OR ‘‘Patient Health
Questionnaire 2’’ OR PHQ-2 OR ‘‘Symptom Checklist 90’’ OR SCL-90 OR WHO-5 OR ‘‘Depression
Anxiety Stress Scales’’ OR DASS-21 OR ‘‘Generalized Anxiety Disorder questionnaire’’ OR GADQ OR
‘‘Generalized Anxiety Disorder 7’’ OR GAD-7 OR ‘‘Hamilton Anxiety Rating Scale’’ OR HARS OR screen

OR questionnaire OR evaluation OR diagnost OR assessment OR measure OR test OR tests OR scale

OR inventory OR inventories)) AND NOT TITLE(child OR infant OR teen OR youth OR adolescen
OR pediatric OR paediatric))
Limited to 2005-2018 and English
(n ¼ 3269)
Web of Science (entire core collection)

(((‘‘myocardial’’ OR ‘‘cardiac’’ OR ‘‘heart’’) NEAR/2 (‘‘infarct’’ OR ‘‘ischemi’’ OR ‘‘ischaemi’’)) OR
‘‘AMI’’ OR ‘‘MI’’ OR ‘‘STEMI’’ OR ‘‘NSTEMI’’ OR (‘‘ST’’ NEAR/2 (‘‘elevat’’ OR ‘‘depress’’)) OR
(‘‘heart’’ NEAR/2 ‘‘attack’’) OR (‘‘coronary’’ NEAR/2 (‘‘syndrome’’ OR ‘‘disease’’ OR ‘‘event’’
OR ‘‘occlusion’’ OR ‘‘stenos’’ OR ‘‘thrombo’’)) OR ‘‘ACS’’ OR ‘‘STEACS’’ OR ‘‘NSTEACS’’ OR
‘‘CAD’’ OR ‘‘CHD’’ OR (‘‘Myocardial’’ NEAR/2 ‘‘Revasculari’’) OR ‘‘coronary artery bypass’’ OR
‘‘CABG’’ OR ‘‘aortocoronary bypass’’ OR ‘‘angioplast’’ OR ((‘‘coronary’’ OR ‘‘arterial’’) NEAR/4
‘‘dilat’’) OR ‘‘PTCA’’ OR (‘‘percutaneous coronary’’ NEAR/2 (‘‘interven’’ OR ‘‘revascular’’)) OR
‘‘PCI’’ OR (‘‘endoluminal’’ NEAR/2 ‘‘repair’’)) AND (‘‘depression’’ OR ‘‘depressive’’ OR ‘‘dysthymi’’
OR ‘‘bipolar’’ OR ‘‘anxiety’’ OR ‘‘GAD’’ OR ‘‘mood disorder’’ OR ‘‘affective disorder’’ OR ‘‘dysregu-
lation disorder’’) AND (‘‘hospitali’’ OR ‘‘inpatient’’ OR ‘‘in-patient’’ OR ‘‘coronary’’ OR ‘‘cardi’’ OR
‘‘acute care’’ OR ‘‘critical care’’) AND (‘‘Beck Depression Inventory’’ OR ‘‘BDI’’ OR ‘‘Beck Anxiety
Inventory’’ OR ‘‘BAI’’ OR ‘‘Beck Hopelessness Scale’’ OR ‘‘BHS’’ OR ‘‘Beck Scale for Suicide Ideation’’
OR ‘‘BSS’’ OR ‘‘Center for Epidemiologic Studies Depression Scale’’ OR ‘‘CES-D’’ OR ‘‘CESD-R’’ OR
‘‘Center for Epidemiologic Studies Depression Scale Revised’’ OR ‘‘CESD-R’’ OR ‘‘Hamilton Rating Scale
for Depression’’ OR ‘‘HRSD’’ OR ‘‘HAM-D’’ OR ‘‘Hamilton Depression Rating Scale’’ OR ‘‘HDRS’’ OR
‘‘Hospital Anxiety and Depression Scale’’ OR ‘‘HADS’’ OR ‘‘Major Depression Inventory’’ OR ‘‘MDI’’ OR
‘‘patient health questionnaire 9’’ OR ‘‘PHQ-9’’ OR ‘‘Patient Health Questionnaire 2’’ OR ‘‘PHQ-2’’
OR ‘‘Symptom Checklist 90’’ OR ‘‘SCL-90’’ OR ‘‘WHO-5’’ OR ‘‘Depression Anxiety Stress Scales’’ OR
‘‘DASS-21’’ OR ‘‘Generalized Anxiety Disorder questionnaire’’ OR ‘‘GADQ’’ OR ‘‘Generalized Anxiety
Disorder 7’’ OR ‘‘GAD-7’’ OR ‘‘Hamilton Anxiety Rating Scale’’ OR ‘‘HARS’’ OR ‘‘screen’’ OR
‘‘questionnaire’’ OR ‘‘evaluation’’ OR ‘‘diagnost’’ OR ‘‘assessment’’ OR ‘‘measure’’ OR ‘‘test’’ OR
‘‘tests’’ OR ‘‘scale’’ OR ‘‘inventory’’ OR ‘‘inventories’’))
Limited to: 2005 – 2018
Language: English
Research areas: CARDIAC CARDIOVASCULAR SYSTEMS, PSYCHIATRY, MEDICINE GENERAL
INTERNAL, PSYCHOLOGY, PUBLIC ENVIRONMENTAL OCCUPATIONAL HEALTH, PSYCHOL-
OGY MULTIDISCIPLINARY, NEUROSCIENCES, PSYCHOLOGY CLINICAL, CLINICAL NEUROL-
OGY, SURGERY, CRITICAL CARE MEDICINE, PHYSIOLOGY, BEHAVIORAL SCIENCES,
PSYCHOLOGY BIOLOGICAL, PSYCHOLOGY APPLIED, INSTRUMENTS INSTRUMENTATION
(n ¼ 3835)

Appendix II: Studies ineligible following full-text review
Abedimanesh N, Ostadrahimi A, Bathaie SZ, Abedimanesh S, Motlagh B, Jafarabadi MA, et al. Effects of
saffron aqueous extract and its main constituent, crocin, on health-related quality of life, depression, and
sexual desire in coronary artery disease patients: a double-blind, placebo-controlled, randomized clinical
trial. Iran Red Crescent Med J. 2017;19(9):e13676.
Reason for exclusion: Screening for depression was undertaken for inclusion into a study and was not part
of practice.
Alhurani A, McKee G, Odonnell S, Obrien F, Mooney M, Lennie T, et al. The association of persistent
symptoms of depression and anxiety with recurrent acute coronary syndrome events: a prospective
observational study. Int J Health Sci (Qassim). 2018;12(2):50–6.
Reason for exclusion: Conference abstract; not enough information to determine screening tool use. Author
contacted; however, study not obtained.
Asgari M, Jafarpoor H, Soleimani M, Ghorbani R, Jafarypoor I, Askandarian R. Effects of early mobilization
program on depression of patients with myocardial infarction hospitalized in CCU. Koomesh.
2014;16(2):175-84.
Reason for exclusion: This study did not screen for depression.
Bahrami T, Rejeh N, Heravi-Karimooi M, Vaismoradi M, Tadrisi SD, Sieloff C. Effect of aromatherapy
massage on anxiety, depression, and physiologic parameters in older patients with the acute coronary
syndrome: a randomized clinical trial. Int J Nurs Pract. 2017;23(6):e12601.
of practice.
Bashiri Z, Aghajani M, Alavi NM. Effects of psychoeducation on mental health in patients with coronary
heart disease. Iran Red Crescent Med J. 2016;18(5):e25089.
Reason for exclusion: This study was interested in mental health more broadly and did not specifically screen
for depression.
Batcha M, James AGW, Annamalai A. Study on psychosocial stressors and psychiatry morbidity in acute
myocardial infarction: a quantitative study. J Evol Med Dent Sci. 2016;5(52):3445-52.
Reason for exclusion: This study was interested in stressful life events, and not specifically depression.
Beach SR, Januzzi JL, Mastromauro CA, Healy BC, Beale EE, Celano CM, et al. Patient health question-
naire-9 score and adverse cardiac outcomes in patients hospitalized for acute cardiac disease. J Psychosom
Res. 2013;75(5):409-13.
Reason for exclusion: This study was not limited to acute coronary syndrome (ACS) patients.
Celano CM, Suarez L, Mastromauro C, Januzzi JL, Huffman JC. Feasibility and utility of screening for
depression and anxiety disorders in patients with cardiovascular disease. Circ Cardiovasc Interv.
2013;6(4):498-504.
Reason for exclusion: This study was not limited to ACS patients.
Charite University. Depression care for hospitalized coronary heart disease patients: prospective cohort
study. Muenster: Berlin Germany University Hospital; 2015.
Reason for exclusion: Clinical trial without any published results.
Charite University. Systematic screening for comorbid psychological conditions in cardiac ACS patients with
multimorbidity in the ED. In: German Federal Ministry of Education Research editor. Berlin
Germany. 2018.

Columbia U, National Heart L, Blood I, Duke U, HealthPartners I, Kaiser Foundation Research Institute.
Comparison of depression identification after acute coronary syndrome: quality of life and cost
outcomes. 2018.
Dal Boni ALM, Martinez JE, da Silva Saccomann ICR. Quality of life of patients undergoing coronary artery
bypass grafting. Acta Paul Enferm. 2013;26(6):575-80.
Reason for exclusion: Screening occurred outside of the acute hospitalization setting.
Damen NL, Versteeg H, Serruys PW, van Geuns RJM, van Domburg RT, Pedersen SS, et al. Cardiac patients
who completed a longitudinal psychosocial study had a different clinical and psychosocial baseline profile
than patients who dropped out prematurely. Eur J Prev Cardiol. 2015;22(2):196-9.
Reason for exclusion: Depression screening occurred post-discharge.
Davidson KW, Wasson LT, Kronish IM. Should you screen for and manage depression in patients with a
recent acute coronary syndrome? Ann Intern Med. 2017;167(10):750-1.
Reason for exclusion: Not primary research.
Dekel R, Vilchinsky N, Liberman G, Leibowitz M, Khaskia A, Mosseri M. Marital satisfaction and
depression among couples following men’s acute coronary syndrome: testing dyadic dynamics in a
longitudinal design. Br J Health Psychol. 2014;19(2):347-62.
Reason for exclusion: This study was interested in the contribution of marital satisfaction to symptoms of
depression among patients with ACS and did not focus on screening in an acute care setting.
Di Stefano R, Felice F, Pini S, Mazzotta G, Bovenzi FM, Bertoli D, et al. Impact of depression on circulating
endothelial progenitor cells in patients with acute coronary syndromes: a pilot study. J Cardiovasc Med.
2014;15(4):353-9.
Reason for exclusion: This was a pilot study to an already included study.
Doering LV, Chen B, Bodan RC, Magsarili MC, Nyamathi A, Irwin MR. Early cognitive behavioral therapy
for depression after cardiac surgery. J Cardiovasc Nurs. 2013; 28(4):370-9.
of practice.
Donnelly TT, Al Suwaidi JM, Al-Qahtani A, Asaad N, Fung T, Singh R, et al. Mood disturbance and
depression in Arab women following hospitalisation from acute cardiac conditions: a cross-sectional study
from Qatar. BMJ Open. 2016; 6(7):7.
Feng L, Zhao L, Ma X. Evaluation of multidisciplinary collaborative care management in patients with both
acute coronary syndrome and depression and/or anxiety disorders. [Journal: Conference Abstract]. [cited
2018 Jun 12} Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/959/CN-
01249959/frame.html
of practice.
First Affiliated Hospital Xi’an Jiaotong, Shaanxi Provincial People’s Hospital, Xi An No Hospital, Baoji
Central Hospital, General Hospital of Ningxia Medical University, The People’s Hospital of Ningxia, et al.
The impact of depression and/or anxiety on PCI patients. 2017.
George Institute for Global Health. Integrating depression care in acute coronary syndromes care in
China. 2018.

Greco A, Luyckx K, Baretta D, Cappelletti E, D’Addario M, Monzani D, et al. Longitudinal trajectories of

depression and lifestyle behaviours in acute coronary syndrome patients. [Journal: Conference Abstract].
[cited 2018 Jun 12] Available from: https://esc365.escardio.org/Congress/Acute-Cardiovascular-Care-2016/
Poster-Session-4-Secondary-prevention/143599-longitudinal-trajectories-of-depression-and-lifestyle-behav-
iours-in-acute-coronary-syndrome-patients
Reason for exclusion: Conference abstract, unable to find full study. Author contacted; however, study
not obtained.
Hosseini SH, Ghaemian A, Mehdizadeh E, Ashraf H. Contribution of depression and anxiety to impaired
quality of life in survivors of myocardial infarction. Int J Psychiatry Clin Pract. 2014;18(3):175-81.
Reason for exclusion: This is an analysis of the same group of participants but reporting on
different outcomes.
Huffman J, Mastromauro C, Beach S, Celano C, DuBois C, Healy B, et al. The mosaic study: randomized
trial of a low-intensity collaborative care intervention for depression and anxiety disorders in patients with
acute cardiac illness. [Journal: Conference Abstract]. [cited 2018 Jun 12] Available from: http://cochraneli-
brary-wiley.com/o/cochrane/clcentral/articles/467/CN-01061467/frame.html
Reason for exclusion: Conference abstract, full study included for full text review.
Huffman JC, Mastromauro CA, Beach SR, Celano CM, DuBois CM, Healy BC, et al. Collaborative care for
depression and anxiety disorders in patients with recent cardiac events: the management of sadness and
anxiety in cardiology (MOSAIC) randomized clinical trial. JAMA Intern Med. 2014; 174(6):927-35.
of practice.
Jaffer F, Grantham J, Sapontis J, Spertus J, Gosch K, Jones P, et al. Interrelationship between depression,
angina, and dyspnea before and after CTO PCI in the OPEN CTO registry. 2016. [Journal: Conference
Abstract]. [cited 2018 Jun 12] Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/
articles/567/CN-01303567/frame.html
Reason for exclusion: Conference abstract; insufficient information for inclusion. Unable to contact author.
Joubert L, Holland L, Maturano A, Lee J, McNeill J. The contribution of psychosocial factors to secondary
risk prevention for myocardial infarction in young adults. Health Soc Care Community. 2013;52(2-3):191-
206.
Reason for exclusion: This study did not screen for depression.
Kang HJ, Stewart R, Bae KY, Kim SW, Shin IS, Hong YJ, et al. Effects of depression screening on psychiatric
outcomes in patients with acute coronary syndrome: findings from the K-DEPACS and EsDEPACS studies.
Int J Cardiol. 2015;190:114-21.
Kang H-J, Stewart R, Bae K-Y, Kim S-W, Shin I-S, Hong YJ, et al. Predictors of depressive disorder following
acute coronary syndrome: Results from K-DEPACS and EsDEPACS. J Affect Disord. 2015;181:1-8.
Kidd T, Poole L, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Health-related personal control predicts
depression symptoms and quality of life but not health behavior following coronary artery bypass graft
surgery. Int J Behav Med. 2016; 39(1):120-7
Reason for exclusion: Depression screening occurred prehospitalization.
Kuhlmann SL, Tschorn M, Arolt V, Beer K, Brandt J, Grosse L, et al. Serum brain-derived neurotrophic
factor and stability of depressive symptoms in coronary heart disease patients: a prospective study.
Psychoneuroendocrinology. 2017; 77:196-202.

of practice.
Li S, Blumenthal JA, Shi C, Millican D, Li X, Du X, et al. I-CARE randomized clinical trial integrating
depression and acute coronary syndrome care in low-resource hospitals in China: design and rationale. J Clin
Rehab Tissue Eng Res. 2010;14(31):5833-6.
Reason for exclusion: This was not primary research; protocol for design and rationale.
Massachusetts General Hospital, National Heart Lung, Blood Institute. Pragmatic collaborative care for
cardiac inpatients with depression or anxiety. 2017. ClinicalTrials.gov Identifier: NCT0311875
Reason for exclusion: This was not primary research; protocol for design and rationale.
McGill University. Bright light therapy efficacy for depressive symptoms following cardiac surgery or acute
coronary syndrome: pilot trial. 2017. ClinicalTrials.gov Identifier: NCT02621567
McGuire AW, Eastwood J-A, Hays RD, Macabasco-O’Connell A, Doering LV. Depressed or not depressed:
untangling symptoms of depression in patients hospitalized with coronary heart disease. Am J Crit Care.
2014;23(2):106-16.
Reason for exclusion: This was a pooled secondary analysis of three studies (one of which was already
included and one of which was deemed ineligible for inclusion).
Mittag O, Kampling H, Farin E, Tully PJ. Trajectories of depressive symptoms after a major cardiac event. J
Health Psychol. 2016;3(1).
Reason for exclusion: Depression screening occurred post-discharge and was not limited to ACS patients.
Nakamura S, Kato K, Yoshida A, Fukuma N, Okumura Y, Ito H, et al. Prognostic value of depression,
anxiety, and anger in hospitalized cardiovascular disease patients for predicting adverse cardiac outcomes.
Am J Cardiol. 2013;111(10):1432-6.
Nedeljkovic I. Assessment of depression and anxiety in patients before and after percutaneous coronary
intervention: A step forward in cardiac rehabilitation? Eur J Prev Cardiol. 2018;25(10): 1015–16.
Reason for exclusion: This was not primary research.
Norwegian Heart Lung Patient Organization, The. Screening for depression and anxiety in patients with
heart disease. Sykepleien. 2017;12(60372):(e-60372)
Nunes J, de Figueiredo JA, de Sousa RML, Costa V, Silva F, da Hora A, et al. Depression after CABG: a
prospective study. Rev Bras Cir Cardiovasc. 2013;28(4):491-7.
Oflaz S, Yuksel S, Sen F, OzdemIroglu F, Kurt R, Oflaz H, et al. Does illness perception predict posttraumatic
stress disorder in patients with myocardial infarction? Noropsikiyatri Arsivi. 2014;51(2):103-9.
Reason for exclusion: This study was interested in acute stress disorder and post-traumatic stress disorder,
and not specifically depression.
Oranta O, Luutonen S, Salokangas R, Vahlberg T, Leino-Kilpi H. Nurse-led interpersonal counseling for
depressive symptoms in patients with myocardial infarction. [Journal: Conference Abstract]. [cited 2018
June 12] Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/359/CN-01024359/
frame.html
https://www.karger.com/Article/Pdf/355890
Reason for exclusion: Conference abstract, unable to find full study. Author contacted; however, study
not obtained.

Page MG, Watt-Watson J, Choiniere M. Do depression and anxiety profiles over time predict persistent post-
surgical pain? A study in cardiac surgery patients. Eur J Pain. 2017;21(6):965-76.
Patron E, Benvenuti SM, Zanatta P, Polesel E, Palomba D. Preexisting depressive symptoms are associated
with long-term cognitive decline in patients after cardiac surgery. Gen Hosp Psychiatry. 2013;35(5):472-9.
Reason for exclusion: This study was interested in post-operative cognitive decline in patients after cardiac
surgery, and not specifically depression.
Perrotti A, Mariet A-S, Durst C, Monaco F, Vandel P, Monnet E, et al. Relationship between depression and
health-related quality of life in patients undergoing coronary artery bypass grafting: a MOTIV-CABG
substudy. Qual Life Res. 2016;25(6):1433-40.
Piegza M, Jaszke M, Scislo P, Pudlo R, Badura-Brzoza K, Piegza J, et al. Symptoms of depression and anxiety
after cardiac arrest. Psychiatr Pol. 2015;49(3):465-76.
Poole L, Kidd T, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Depression, C-reactive protein and length of
post-operative hospital stay in coronary artery bypass graft surgery patients. Brain Behav Immun.
2014;37(100):115-21.
Poole L, Kidd T, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Psychological distress and intensive care unit
stay after cardiac surgery: the role of illness concern. Health Psychol. 2015; 34(3):283-7.
Poole L, Leigh E, Kidd T, Ronaldson A, Jahangiri M, Steptoe A. The combined association of depression and
socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft
surgery: data from a prospective cohort study. J Psychosom Res. 2014; 76(1):34-40.
Poponina T, Poponina Y, Gunderina K, Soldatenko M, Markov V. The mental status state of patients with
arterial hypertension associated with acute coronary syndrome. [Journal: Conference Abstract]. [cited 2018
June 12] Available from: http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/476/CN-01135476/
frame.html
Reason for exclusion: Conference abstract, insufficient information for inclusion. Full study not published
in English.
Pragle AS, Salahshor S. Identifying and managing depression in patients with coronary artery disease.
JAAPA. 2018;31(5):12-8.
Reason for exclusion: This is not a primary study; it is an assessment of screening.
Rasputina L, Rasputin V, Ovcharuk M, Serhiichuk O, Broniuk A. Prevalence of depression and its grading in
patients with coronary heart disease. Georgian Med News. 2016;(259):48-53.
Reason for exclusion: Unable to retrieve full text. Author contacted; however, study not obtained.
Rude J, Azimova K, Dominguez C, Sarosiek J, Edlavitch S, Mukherjee D. Depression as a predictor of length
of stay in patients admitted to the cardiovascular intensive care unit at a university medical center.
Angiology. 2014;65(7):580-4.
Rutledge T, Kenkre TS, Thompson DV, Bittner VA, Whittaker K, Eastwood JA, et al. Depression, dietary
habits, and cardiovascular events among women with suspected myocardial ischemia. Am J Med.
2014;127(9):840-7.

Reason for exclusion: Depression assessment was conducted post hospital event.
Sang CH, Chen K, Pang XF, Dong JZ, Du X, Ma H, et al. Depression, anxiety, and quality of life after
catheter ablation in patients with paroxysmal atrial fibrillation. Clin Cardiol. 2013;36(1):40-5.
Sipotz J, Friedrich O, Hofer S, Benzer W, Chatsakos T, Gaul G, et al. Health related quality of life and mental
distress after PCI: restoring a state of equilibrium. Health and quality of life outcomes. Health Qual Life
Outcomes. 2013;11:144.
Reason for exclusion: This study examined mental distress and not specifically on depression.
Ski CF, Worrall-Carter L, Cameron J, Castle DJ, Rahman MA, Thompson DR. Depression screening and
referral in cardiac wards: a 12-month patient trajectory. Eur J Cardiovasc Nurs. 2017;16(2):157-66
Tatishvili S, Jorbenadze R, Kavtaradze G. Association of depression with hospital length of stay in patients
with acute coronary syndrome. Georgian Med News. 2016;(252):22-6.
Reason for exclusion: Abstract only. The full study is included.
Tuñón JLM, Rodrı́guez IP, Pérez AP. Depression following an acute coronary syndrome in hospitalized
patients: prevalence and associated variables. Ansiedad Estres. 2014;20(1):75-88.
Reason for exclusion: Publication not available in English language.
University of Bologna. Treatment of depression in acute coronary syndrome (ACS) patients. 2018.
Vaezi AA, Parizi S, Vahidi AR, Tavangar H. Study the effect of inhalation of peppermint oil on depression
and anxiety in patients with myocardial infarction who are hospitalized in intensive care units of Sirjan. J
Med Plants Res. 2017;16(62):55-62.
Reason for exclusion: Publication not available in English language.
Zarea K, Maghsoudi S, Dashtebozorgi B, Hghighizadeh MH, Javadi M. The impact of Peplau’s Therapeutic
Communication Model on anxiety and depression in patients candidate for coronary artery bypass. Clin
Pract Epidemiol Ment Health. 2014;10:159-65.
Reason for exclusion: This study was not undertaken in the acute hospital setting.

Appendix III: Data extraction tool
General information
Date form completed (dd/mm/yyyy)
Name of person extracting data
Study – surname of first author, et al. (year)
Study author contact details
Publication type (e.g. peer-review journal article, abstract, letter)
Methods
Descriptions as stated in article Location (pg no.)
Recruitment (e.g. consecutive/non-consecutive)
Design (e.g. RCT, non-RCT, observational, case-control)
Unit of allocation (e.g. by individuals, cluster/ groups or body parts)
Start date
End date
Duration of participation (from recruitment to last follow-up)
Number of follow-ups
Time of follow-up (e.g. three, six and nine months)
Results Intervention Comparison
No. with event Total in group No. with Total in

event group
Any other results reported (e.g. odds ratio, risk difference, CI or P value)
Notes:

Participants
Descriptions as stated in article Location (pg no.)
Population description (e.g. type of ACS)
Setting (e.g. location and social context)
Withdrawals and exclusions

(check PRISMA)
Age
Sex
Baseline depression (including tool used to determine diagnosis)
Sub-groups measured
Sub-groups reported
Notes:
Outcomes
Description as stated in report/paper Location (pg no.)
Time points measured
Time points reported
Outcome definition
Tool(s) used (may be more than one)
Name of tool (1)
Is tool validated in the population? Scales: upper and lower limits:
Name of tool (2)
Name of tool (3)
Name of tool (4)
Notes:
Other information
Description as stated in report/paper Location (pg no.)
Key conclusions of study authors
References to other relevant studies
Notes:

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S YS T E M AT I C R E V I E W

Screening for depression and anxiety among patients

Correspondence: Tania S. Marin, tania.marin@flinders.edu.au

JBI Evidence Synthesis ß 2020 JBI 1932

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Introduction with ACS in primary care, reinforcing that effective

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Types of sources were screened by three independent reviewers for

Search strategy Data extraction

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Records identified through database Additional records identified through other

Records after duplicates removed

Records screened Records excluded

Full-text articles assessed for Full text articles excluded, with

• Inclusion criteria not met

Studies included in synthesis

Figure 1: Search results and study selection and inclusion process21

JBI Evidence Synthesis ß 2020 JBI 1936

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Characteristics of included studies methodologies (prospective and retrospective) with

Table 1: Characteristics of included studies

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Screening tool Cut-off score Author, date (country)

PHQ-II (PHQ-2)16 3 McGuire, 2013 (USA)39

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Screening tool Cut-off score Author, date (country)

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JBI Evidence Synthesis ß 2020 JBI 1945

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JBI Evidence Synthesis ß 2020 JBI 1946

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JBI Evidence Synthesis ß 2020 JBI 1947

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JBI Evidence Synthesis ß 2020 JBI 1948

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JBI Evidence Synthesis ß 2020 JBI 1949

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JBI Evidence Synthesis ß 2020 JBI 1950

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Appendix I: Search strategy

Database Records retrieved

Ovid MEDLINE 3709

48 (child or infant or teen or youth or adolescen or p?ediatric).ti. 1,119,387

OR questionnaire OR evaluation OR diagnost OR assessment OR measure OR test OR tests OR scale