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From the Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
Address correspondence and reprint requests to Roy C. Ziegelstein, MD, Department of Medicine, Division of Cardiology, Johns Hopkins Bayview Medical Center, Room 108B, 4940 Eastern Avenue, Baltimore, MD 21224-2780. E-mail: rziegel{at}jhmi.edu
Objective: The objective of this study was to determine the ability of cardiovascular healthcare workers to assess the presence or absence of symptoms of depression in patients hospitalized with acute myocardial infarction (AMI) in the absence of formal screening.
Methods: Patients admitted with AMI underwent screening using the Beck Depression Inventory (BDI) administered by a research assistant. The cardiovascular nurse, medicine resident or intern, and attending cardiologist caring for the patient were then approached (blinded to the BDI results) and asked to assess, using a visual analog scale, whether the patient had symptoms that would warrant further evaluation for depression.
Results: BDI screening and at least one provider assessment were completed for 60 patients with AMI. A total of 18 of 60 patients (30.0%) had a BDI score of 
10. Symptoms of depression were considered not present in 24 of 32 patient assessments when the BDI was 10 (75% false-negatives). The mean BDI score of patients assessed as depressed by at least one provider (6.7 ± 6.3) was no different from the mean BDI score of patients assessed as not depressed (7.5 ± 7.2, p = .67). Overall, there was little correlation between BDI scores and provider assessments, and this was not influenced by provider type or provider gender.
Conclusions: Cardiovascular nurses and medicine residents and interns underrecognize depression in patients with AMI in the absence of formal screening. Formal screening for symptoms of depression should be considered part of routine AMI care.
Key Words: acute myocardial infarction • depression • Beck Depression Inventory • cardiovascular nurse • visual analog scale
Abbreviations: AMI = acute myocardial infarction; BDI = Beck Depression Inventory; CPK = creatine phosphokinase; D-VAS = depression–visual analog scale; DIS = Diagnostic Interview Schedule.
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