Assessment of Depression After Stroke

Abstract

Background and Purpose— Assessing poststroke depression may be complicated by aphasia, other cognitive deficits, and several somatic stroke-related symptoms. We studied the possible differences in performance of some commonly used instruments in screening depression after stroke. Methods— We compared the Beck Depression Inventory, Hamilton Rating Scale for Depression, Visual Analogue Mood Scale, proxy assessment, and Clinical Global Impression of the nursing and study personnel, together with Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised diagnosis, in assessing depression after stroke in a follow-up study of 100 patients. The patients were studied at 2 weeks and at 2, 6, 12, and 18 months after stroke. Results— The feasibility rates of all assessment instruments studied were fairly similar, but the prevalence rates differed according to the assessment instruments, varying from the lowest rates with a Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised-based diagnosis up to 3-fold with caregiver ratings. The sensitivity and specificity against the Diagnostic and Statistical Manual of Mental Disorders criteria were acceptable with the Clinical Global Impression, Beck Depression Inventory, and Hamilton Rating Scale for Depression, mostly in the range of 0.70 to 1.00. The caregiver ratings were higher than the patient ratings ( P <0.001) and correlated with the caregiver’s own Beck Depression Inventory (0.60 to 0.61, P <0.001). The Visual Analogue Mood Scale was not a sensitive instrument (sensitivity, 0.20 to 0.60) and did not correlate with the Beck Depression Inventory during the first year after stroke. Conclusions— Beck Depression Inventory, Hamilton Rating Scale for Depression, and Clinical Global Impression assessment by professionals, in addition to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised diagnosis, are useful in assessing depression, but none of these instruments clearly stood apart from the others. Proxy ratings should be used with caution, and the use of the Visual Analogue Mood Scale among patients with aphasia and other cognitive impairments cannot be recommended.

A cross-sectional study of prevalence and determinants of depression among stroke patients

“…Williams et al had evaluated the performance of PHQ-9 in assessing post-stroke depression and concluded that PHQ-9 scores discriminate equally well between those with and without PSD regardless of age, gender, or ethnicity and also it was superior to other scales used to assess depression. 7 Demographic variables serve an important role in the development of post-stroke depression. Depressive symptoms were more prevalent among those who were below 60 years of age.…”

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

“…This score is in the range originally indicated to characterize mild to moderate depression, 21 but it is up to 4 points above the cutoff for patients with stroke considering similar sensitivity and specificity. 33,34 In the case of the HADS, one review 35 of studies conducted in patients with general medical conditions described optimal cutoff points ranging from 3 to 11 for the depression subscale, with 8 as the cutoff most commonly found; this is also the score originally suggested by the authors of the scale. 22 With regard to TBI, one previous study 9 found a sensitivity of 62% and specificity of 92% for a score of 8 or higher on the HADS, whereas another 11 found a sensitivity of 80% and specificity of 73% for this same cutoff point.…”

Post-stroke depression

“…A stroke-ot követő hangulatzavarok gyakoriságára vonatkozó szakirodalmi adatok a PSD defi níciójától, a vizsgált betegcsoporttól, a vizsgálat időpontjától és a vizsgá-latban használt kérdőívektől függően nagyon eltérőek [22,23,24]. A legalacsonyabb érték 1,5%-ban [11], a legmagasabb értéket tartalmazó tanulmány 68%-ban [25] jelöli meg a stroke-ot követő depresszió előfordu-lási gyakoriságát.…”

“…A PSD felismerésére önértékelő skálák, illetve interjú formájában kitöltendő kérdőívek állnak rendelkezésre. Az agyérkatasztrófát követő depresszió felismeré-sére megbízhatóan alkalmazhatók a Hamilton Depreszszió Becslő Skála [41], a Beck Depresszió Skála [42], valamint a Montgomery-Asberg Depresszióértékelő Skála (MADRS) [23,43,44].…”