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Background and Purpose-The purpose of this study was to examine the performance of the Patient Health Questionnaire (PHQ)-9, a 9-item depression scale, as a screening and diagnostic instrument for assessing depression in stroke survivors. Methods-As part of a randomized treatment trial for poststroke depression (PSD), subjects with and without PSD completed the PHQ-9, a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily). Subjects endorsing 2 or more symptoms of depression were administered the criterion standard Structured Clinical Interview for Depression (SCID). Receiver operating characteristic analysis was used to examine the sensitivity and specificity of the PHQ-9 Results-Of 316 subjects enrolled, 145 met SCID criteria for major depression or other depressive disorder, and 171 were not depressed. PHQ-9 scores discriminated well between subjects with any versus no depressive disorder, with an area under the curve (AUC) of 0.96, as well as between subjects with and without major depression (AUCϭ0.96). The AUC was similar regardless of patient age, gender, or ethnicity. A PHQ-9 score Ն10 had 91% sensitivity and 89% specificity for major depression, and 78% sensitivity and 96% specificity for any depression diagnosis. Conclusions-The PHQ-9 performs well as a brief screener for PSD with operating characteristics similar or superior to other depression measures and similar to its characteristics in a primary care population. Moreover, PHQ-9 scores discriminate equally well between those with and without PSD regardless of age, gender, or ethnicity. Key Words: depression Ⅲ stroke P oststroke depression (PSD) affects approximately onethird of ischemic stroke survivors, is often undiagnosed and inadequately treated, and is associated with increased morbidity and mortality after stroke. 1-4 Depression screening after stroke is thus important but can be complicated by cognitive and physical symptoms of stroke that may introduce additional variability in assessment of depressive symptoms and depression diagnosis. Although several established depression screening instruments have been validated in stroke cohorts, 5-10 these scales can be burdensome for patients to complete, require a trained interviewer to administer, and often are designed only for screening and not as a diagnostic depression tool. The Patient Health Questionnaire 9-item depression scale (PHQ-9) is a 9-item self-administered depression screening and diagnostic tool increasingly used in primary care and other medical populations. 11,12 Although it has excellent measurement properties in other settings, it has not been previously validated in patients with PSD. The purpose of this study was to examine the performance of the PHQ-9 as a screening and diagnostic instrument for assessing depression in ischemic stroke survivors. Subjects and MethodsSubjects were patients enrolled in the National Institute for Neurologic Disorders and Stroke-funded AIM (Activate, Initiate treatment, Monitor) PSD study....

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BackgroundA systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models.MethodsOnline search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria.ResultsOf 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice.ConclusionsRecommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.

The revised 15-item BCOS has evidence of satisfactory reliability and validity in family caregivers of stroke survivors. The BCOS is a valuable measure in research and can be used to identify priority areas for nursing interventions designed to improve caregivers' outcomes.

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Physical activity after stroke may prevent disability and stroke recurrence; yet, physical impairments may inhibit poststroke exercise and subsequently limit recovery. The goal of this study was to elicit barriers to and facilitators of exercise after stroke. We conducted three focus groups and achieved content saturation from 13 stroke survivors--eight men and five women--85% of whom were African American and 15% White, with a mean age of 59 years. We coded and analyzed the transcripts from the focus groups for common themes. Participants across groups reported three barriers (physical impairments from stroke, lack of motivation, and environmental factors) and three facilitators (motivation, social support, and planned activities to fill empty schedule) to exercise after stroke. Exercise activity can provide a purpose and structure to a stroke survivor's daily schedule, which may be interrupted after stroke. In addition, receiving social support from peers and providers, as well as offering stroke-specific exercise programming, may enhance physical activity of stroke survivors including those with disabilities. We intend to incorporate these findings into a post-stroke self-management exercise program.

S troke is one of the leading causes of severe, long-term disability, 1 with a majority of stroke survivors requiring the assistance of a family caregiver.2 A family caregiver is defined in this context as a relative, partner, personal friend, or neighbor who provides assistance to an adult with a chronic or disabling condition such as stroke.3 Although family members may not consider themselves caregivers, this term is commonly used in the literature to represent family or informal (unpaid) caregivers.Family caregiver stress is commonly associated with longterm institutionalization of stroke survivors, resulting in significant costs to the healthcare system. [4][5][6][7][8] Family caregiver stress can also result in other negative outcomes for both survivors and their caregivers. 7 For example, caregiver stress has been shown to interfere with rehabilitation of the survivor 7 and can result in social isolation, declining health, and increased risk of mortality for the caregivers. 9,10 Depression is especially prevalent in stroke family caregivers, 7,11,12 with some studies reporting higher depression rates in the caregivers than in the survivors for whom they provide care. 11,13 Miller and colleagues 14 made recommendations for family caregiver education and support across inpatient, outpatient, and chronic care settings based on clinical practice guidelines and existing research. These recommendations involved (1) caregivers serving as integral members of interdisciplinary teams, (2) assessment of caregiver needs and concerns, (3) follow-up contacts and referrals, (4) counseling focused on problem solving and social support, (5) provision of strokerelated information, and (6) attention to the emotional and Abstract-Stroke is a leading cause of severe, long-term disability. Most stroke survivors are cared for in the home by a family caregiver. Caregiver stress is a leading cause of stroke survivor institutionalization, which results in significant costs to the healthcare system. Stroke family caregiver and dyad intervention studies have reported a variety of outcomes. A critical analysis of 17 caregiver intervention studies and 15 caregiver/stroke survivor dyad intervention studies was conducted to provide evidence-based recommendations for the implementation and future design of stroke family caregiver and dyad interventions. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on March 26, 2014. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or ...