2 patients with ACS, no known studies have speciﬁcally eval- uated gender diﬀerences in speciﬁc depressive symptoms reported during the ACS event. The purpose of this study was to examine the gender diﬀerences and prevalence of self- reported depressive symptoms and self-reported somatic depressive symptoms, as measured by the Beck Depression Inventory II (BDI-II) [20], in patients hospitalized for ACS. 2. Methods This was a cross-sectional observational study with a con- venience sample of 789 adults (248 females and 541 males) hospitalized for ACS. The study included all participants meeting the inclusion criteria of a larger study looking at the interactions of genetics and depression on ACS outcomes. The overall rate for males verses females was consistent with the gender ratio for ACS admitted to the facility. Participants were recruited during hospital admission for ACS and were screened for self-reported depressive symptoms, by trained research nurses, using the BDI-II. Depression was deﬁned as a BDI-II score of ≥14 indicating at least moderate symptoms of depression [20]. The study was approved by the University’s Committee for the Protection of Human Subjects Internal Review Board. After informed consent was obtained, by trained research nurses, the BDI-II was administered when the patients were stable enough during their hospital stay to answer the ques- tions (1–3 days after hospital admission). Inclusion criteria consisted of a conﬁrmed diagnosis of ACS and 18 years of age or older. ACS was deﬁned as chest pain or symptoms suggestive of ACS lasting for more than 15 minutes with new transient or persistent ST-wave ischemic electrocardiogram (ECG) changes and ultimate disposition as (1) acute myocar- dial infarction (AMI), including ST-wave elevation infarction and non-ST wave elevation infarction or (2) unstable angina [19]. The ﬁnal ACS diagnosis was veriﬁed through their hospital inpatient medical records. The BDI-II is a reliable and well-validated 21-item de- pression screening scale that uses a forced-choice 4-alterna- tive response format that has been used in the ACS popu- linebreak lation [20]. The BDI-II has been used for 35 years to identify and assess depressive symptoms and reports high reliability (.80) regardless of the population [21, 22]. The construct validity of BDI-II has been established and has shown to be able to diﬀerentiate between depressed and non- depressed individuals. Higher coeﬃcient alphas (.92 for outpatients and .93 for college students) have been reported for the BDI-II when compared to the previous version of the Beck Depression Inventory (BDI) [22]. Test-retest reliability was studied with baseline data obtained on 26 outpatients and therapy sessions one week apart (correlation .93, P < 0.001) [22]. The internal consistency of the BDI-II in patients with ACS has an alpha value of 0.87 [23]. Higher BDI-II scores indicate a greater number of depressive symptoms. BDI-II scores of ≥14 indicate a moderate level of depressive symptoms [20, 24]. This cut-oﬀ score has successfully been used to screen patients hospitalized for ACS (odds ratio, 7.82; 95% CI, 2.42 to 25.26; P = 0.0002) and the internal Nursing Research and Practice consistency of the BDI-II in patients with ACS has an alpha value of 0.87 [24]. Somatic depressive symptoms were measured using BDI- II question 16 (sleep disturbance), question 18 (appetite dis- turbance), and question 20 (fatigue). A patient was identiﬁed as positive for somatic depressive symptoms when the patient rated all three items as 1 or above. If a patient rated 0 on any of the three items, he or she was categorized as negative for somatic depressive symptoms. Pearson chi-square tests for independence (categorical variables) or t-tests for in- dependent samples (continuous variables) were used to examine diﬀerences in demographic characteristics between males and females. Comparisons of depression ordinal scores and symptoms by gender were conducted with Wilcoxon rank sum and Pearson chi-square tests for independence, respectively. Degrees of freedom for the Pearson chi-square test were deﬁned as follows: (r − 1) × (c − 1), where r = the number of rows and c = the number of columns. Signiﬁcance level was set at P < 0.05. Data were analyzed using SAS 9.2 statistical software. 3. Results 3.1. Baseline Characteristics. The sample consisted of 789 adult (248 females and 541 males) patients admitted with ACS (Table 1). Ages ranged from 28 to 96 years. A total of 88 (35%) females and 120 (22%) males had BDI-II scores of 14 or higher. Sixty percent of the patients were hospitalized for their ﬁrst ACS event. The majority of the patients were Caucasian males (64%), with a mean age of 61.35 years (S.D. = 11.56). A signiﬁcantly higher percentage of females were not married (51% for females and 27% for males, P < 0.0001), lived alone (25.5% for females and 17.6% for males, P = 0.0098), and were less physically active (35% for females and 24% for males, P = 0.0002) than males. More than half of females in the study had less than high school education (52%, P < 0.0001), while the majority of males had at least some college or college degree (60%). Females were more likely to currently be taking antidepressants (21.3%) than males (10.57%) (P < 0.0001) and signiﬁcantly more females (31.7%) than males (16.3%) (P < 0.0001) reported a history of depression diagnosis or treatment. 3.2. Prevalence of Self-Reported Depressive Symptoms. Results showed that depression during ACS episodes are diﬀerent be- tween males and females. Signiﬁcantly more females (43.5%) reported feeling depressed over the past year than compared to males (27.2%). During admission for ACS, the average BDI-II scores were signiﬁcantly higher for females (mean = 11.89, S.D. = 9.68) than that for males (mean = 9.00, S.D. = 7.93) (P < 0.0001) indicating that the females reported great- er depressive symptoms. Females reported signiﬁcantly more sadness, self dislike, crying, indecisiveness, sleep disturbance, appetite disturbance, and loss of interest in sex than males (Table 2). Signiﬁcantly more females (7.66%) were identiﬁed as positive for somatic depression symptoms (reported 1 or higher scores on all three questions) than males (2.22%) (P = 0.0003).