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Rehab Measures: Cardiac Depression Scale

Link to instrument


Title of Assessment

Cardiac Depression Scale 


Instrument Reviewer(s)

Initally reviewed by Kristine Flais in November 2013.

Summary Date



To measure depression in adult cardiac patients


  • A self-report 26-item, seven-point Likert-type scale ranging from strongly disagree (1) to strongly agree (7)
  • Minimum score of 26 and maximum score of 182
  • Items 2, 4, 12, 15, 19, 20, and 23 are reversed scored (1 = 7, 2 = 6, 3 = 5, 4 = 4 ,5 = 3, 6 = 2, 7 = 1)
  • A total higher score reflects more severe depressive symptoms

Area of Assessment


Body Part


ICF Domain




Assessment Type


Length of Test

05 Minutes or Less 

Time to Administer

5 minutes

Number of Items


Equipment Required

Test paper and pencil

Training Required


Type of training required

no training 



Actual Cost


Age Range


Administration Mode




Populations Tested

Adult cardiac disease patients (coronary artery disease, heart failure, post-myocardial infarction, non-specific acute coronary symptoms, angina, unstable angina, post-cardiac surgery, angioplasty, post-coronary artery bypass surgery, heart filure, valve disease, arrhythmias, ischemic heart disease)

Standard Error of Measurement (SEM)

Not established

Minimal Detectable Change (MDC)

Not established

Minimally Clinically Important Difference (MCID)

Not established

Cut-Off Scores

Adult cardiac patients:

(Shi et al, 2010; n = 215)

  • A cut off score of > 95 had 97% sensitivity and 85% specificity for major depression as indexed using the Mini-International Neuropsychiatric Interview

(Wise et al, 2006; n = 627; mean age= 58.7 (13.0))

  • Score >100 indicates severe depression with 88% sensitivity and 84% specificity
  • Score of 90 indicates mild to moderate depression with 84% sensitivity and 78% specificity

Normative Data

Not established

Test-retest Reliability

Adult cardiac patients:

(Birks et al, 2004; n = 396; mean age= 67(9))

  • Excellent test-retest reliability (r = 0.79)

Interrater/Intrarater Reliability

Not established

Internal Consistency

Adult cardiac patients:

(Birks et al, 2004)

  • Excellent internal consistency (Cronbach’s alpha = 0.93)

(Hare and Davis, 1996; n = 246; mean age= 59.3 (14.1))

  • Excellent internal consistency (Cronbach’s alpha = 0.90)

(King et al, 2009; n = 120; mean age = 63.54 (10.16); mean post-operative days 6.58 (3.53); status-post first time coronary artery bypass graft surgery data collected at hospital discharge, 6, 12, and 36 weeks post-operatively; males only)

  • Excellent internal consistency (Cronbach’s alpha = 0.86 - 0.91)

(Kiropoulos et al, 2012; n = 152; mean age = 70.34 (8.18); 3.5 months after cardiac hospitalization)

  • Excellent internal consistency (Cronbach’s alpha = 0.91)

(Wise et al, 2006)

  • Excellent internal consistency (Cronbach’s alpha = 0.92)

Criterion Validity (Predictive/Concurrent)

Adult cardiac patients:

(Benedetto et al, 2006; n = 81; mean age=57 (12); 2 weeks post acute coronary syndrome)

  • Excellent correlation with Beck Depression Inventory-II (r = 0.69)

(Birks et al, 2004)

  • Excellent correlation with Beck Depression Inventory (r = 0.78)
  • Excellent correlation with anxiety and depression subscales of the Hospital Anxiety and Depression Scale (r = 0.751 and r = 0.770, respectively)

(Hare and Davis, 1996)

  • Excellent correlation with Beck Depression Inventory (r = 0.73)

(King et al, 2009)

  • Excellent correlation with Beck Depression Inventory (r = 0.751, 0.787, 0.737, 0.819) at baseline, 6, 12, and 36 weeks respectively

(Kiropoulos et al, 2012)

  • Excellent correlation with Beck Depression Inventory-II (r = 0.65)
  • Excellent correlation with State Trait Anxiety Inventory (r = 0.61)

(Wise et al, 2006)

  • Excellent correlation with Geriatric Depression Scale-Short From (r = 0.77)

Construct Validity (Convergent/Discriminant)

Not established

Content Validity

Not established

Face Validity

Not established

Floor/Ceiling Effects

Not established


Not established

Professional Association Recommendations

No recommendations available from APTA


The Cardiac Depression Scale is under copyright. Further information can be obtained from Dr. Samia Toukhsati at or Professor David Hare at
  • The test indexes the full spectrum of depressive symptoms in adult cardiac disease patients
  • The test has excellent reliability, sensitivity and specificity properties
  • The test is easy to administer and no special training is necessary
  • A copy of the test is not readily available which may make it difficult to utilize
  • No standard error of measurement or normative data is available


Birks, Y., Roebuck, A., et al. (2004). "A validation study of the Cardiac Depression Scale (CDS) in a UK population." Br J Health Psychol 9(Pt 1): 15-24. Find it on PubMed

Di Benedetto, M., Lindner, H., et al. (2006). "Depression following acute coronary syndromes: a comparison between the Cardiac Depression Scale and the Beck Depression Inventory II." Journal of psychosomatic research 60(1): 13-20.

Hare, D. L. and Davis, C. R. (1996). "Cardiac Depression Scale: validation of a new depression scale for cardiac patients." J Psychosom Res 40(4): 379-386. Find it on PubMed

King, K. M., Colella, T. J., et al. (2009). "Using the cardiac depression scale in men recovering from coronary artery bypass surgery." Journal of clinical nursing 18(11): 1617-1624.

Kiropoulos, L. A., Meredith, I., et al. (2012). "Psychometric properties of the cardiac depression scale in patients with coronary heart disease." BMC Psychiatry 12(1): 216. Find it on PubMed

Shi, W. Y., Stewart, A. G., et al. (2010). "Major depression in cardiac patients is accurately assessed using the Cardiac Depression Scale." Psychotherapy and psychosomatics 79(6): 391-392.

Wise, F. M., Harris, D. W., et al. (2006). "Validation of the Cardiac Depression Scale in a cardiac rehabilitation population." J Psychosom Res 60(2): 177-183. Find it on PubMed

Year published


Instrument in PDF Format

Approval Status Approved 
Created at 1/3/2014 3:53 PM  by Jason Raad 
Last modified at 6/6/2014 12:10 PM  by Jason Raad