Optimal BDI- Scores For Predicting Depression Among Cardiac Surgical Patients Bret A. Boyer, Heather Coats Institute for Graduate Clinical Psychology, Widener University
Collaborators M.L. Ray Kuretu, MD Kia Crittenden, Ph.D. Kimberly Larson, Ph.D., JD Jennifer Mayer, Ph.D., JD Darlene Link, Psy.D. Erika Kawamura, Psy.D., MBA
Screening for Depression Among CABG Patients Depression is related to increased risk of developing cardiac conditions, higher risk of Myocardial Infarction (MI) among those with coronary artery disease, increased risk of repeat cardiac events after MI, poorer medical and quality-of-life outcomes following MI and CABG. Patients with pre-operative depression show increased risk for sustained depression following surgery (Oxlad & Wade, 008; Stroobant & Vingerhoets, 008; Li, Wang, Xiao, 007, Timerlake et al., 1997). Depression predictive of death following CABG (Blumenthal, Lett, Babyak et al. 003, Burg et al., 003). Minor Depression may be as serious a cardiac risk as Major Depressive Episodes regarding cardiac and mortality outcomes (Carney et al., 008).
Patient Population 66 Patients receiving Emergent CABG (aka., presenting to the emergency with symptoms of acute cardiac event, transitioned to the cardiac catheterization lab, admitted and provided CABG first-thing the next morning. 57% male, 43% women. # of vessels grafted: Mean = 3.73, Mode=4, Median=4 Depression: 15.% MDE, 31% minor depression (subdiagnostic to MDE but clinically significant).
Assessing BDI with Cluster Scoring Symptom Cluster Scoring: Applying DSM-IV-TR Diagnostic Criteria to the responses on a self-report measure, in order to ensure that the severity and pattern of symptom meets criteria for diagnosis. Cluster scoring with the PCL- found fewer false positives with cluster scoring for PTSD, and stronger correlation with the SCID PTSD DX, compared to the use of recommended cut-off scores for the PCL- (Manne, Du Hamel, Gallelli, Sorgen, & Redd, 1998). This scoring strategy has not been tested with the BDI- with patients undergoing CABG.
Which Scoring Best Matches SCID Depression Diagnoses? BDI- Symptom Cluster Score using a score of 1 or higher as significant per item. False Positives False Negatives Correlation with SCID Dx BDI Cluster Scoring (1) 3 1.34 BDI- Symptom Cluster Score using a score of or higher as significant per item. False Positives False Negatives Correlation with SCID Dx BDI Cluster Scoring () 7.43
Which Scoring Best Matches SCID Depression Diagnoses? Cut-off Scores
Scoring for Full BDI Items Total Score False Positives False Negatives Correlation with SCID Dx BDI- 17 Cut-off 5.64 BDI- 18 Cut-off 3.718 BDI- 19 Cut-off 3.718 BDI- 0 Cut-off.764 BDI- 1 Cut-off 4.6 BDI- Cut-off 4.6
Scoring for BDI with Somatic Items Excluded BDI- (No Somatic items) False Positive False Negative Correlation with SCID Dx 10 Cut-off 8.545 11 Cut-off 3.716 1 Cut-off.76 13 cut-off 3.69 14 Cut-off 4 1.676
Why is the symptom Cluster Scoring Less Accurate? Possible confusion by patients of anhedonia and physical limitations on items regarding pleasure and interest. Inability of clinician to follow-up with clarifying questions. Issues of literacy. PTSD self-report measures use items more directly mapped to the DSM Dx Cx, whereas BDI- has 1 items sampling symptoms mapped against 9 DSM Dx Cx.
Issues Regarding Process of Assessment Symptom report of Post-Surgical symptoms while still in the hospital. Where s my eyeglasses? I I don t know what happened to it? sighed the overworked, underpaid, underappreciated SICU nurses and unit clerks. If the SCID works better for pre-operative or immediate post-operative screening, what issues does that pose for follow-up data collection? If data is collected by self-report at follow-up, we are left comparing different measures.
Conclusions & Implications Cut-off score of 0, using all 1 items on the BDI- showed the highest correlation with SCID scoring for MDE (.764). Cut-off Score of 1, using a BDI- scoring without somatic items, showed the highest of BDI- without somatic symptoms for correlation to SCID Dx (.76). Careful preparation for procedural difficulties is needed to prevent lost data/clinical information. Symptom Cluster and Cut-off Scoring for the BDI- need to be tested regarding optimal scoring for depression after CAGB.