Depression Screening in Stroke

Abstract

Background and Purpose— Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard. Methods— Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures. Results— Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78–0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69–0.89) for the Kessler-10 to 0.89 (0.79–0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61–0.83), significantly smaller than the Beck Depression Inventory-II ( P <0.05). Conclusions— Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.

Prevent 2nd Stroke: a pilot study of an online secondary prevention program for stroke survivors

“…Similar to previous studies, the majority of participants reported unsatisfactory levels of vegetable and fruit consumption, physical activity and alcohol consumption. Anxiety and depression was markedly low in our sample compared to previous literature, 4,5 with only one participant reporting severe psychological distress. Quality of life was consistent with previous literature, in which stroke survivors have reported problems with mobility, pain/discomfort and difficulty engaging in their usual activities.…”

“…The program also consists of a loading survey and goals module, which is tailored to the user and provides self‐management opportunities. P2S provides evidence‐based information and strategies that can help to reduce the risk of having another stroke as well as advice on addressing anxiety and depression 5 . The program incorporates behaviour change techniques, 24 such as goal setting and feedback on progress, and is also tailored to encourage positive behaviour change.…”

“…The prevalence of modifiable health risk factors among stroke survivors is high, including physical inactivity, unhealthy diet and smoking, which contribute to 90% of the risk of all strokes 2,3 . Furthermore, depression and anxiety are modifiable affective states that commonly follow a stroke event, and are associated with post‐stroke morbidity and mortality 4,5 . While best practice guidelines 6 propose that prevention of further strokes should begin immediately following a stroke event, and continue indefinitely, it is estimated that 50% of stroke survivors are discharged from hospital without a plan and 67% of hospitals do not report having any protocols in place for reviewing stroke patients post‐discharge 7…”

Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol

“…A cut-off point at 11 has been used in previous studies in stroke population. This cut-off has a good sensitivity and specificity for the detection of depression after a stroke (Turner et al, 2012; Kang et al, 2013). …”

New opinion on the subtypes of poststroke depression in Chinese stroke survivors

“…However, studies on PSD have primarily focused on exploring its prevalence, pathogenic factors as well as treatment 3–7. Only a few researchers have pursued the psychopathology and diagnosis of depression after stroke 8,9. Like other psychiatric disorders, the diagnostic nosology was compelled to focus on clinical manifestations, duration and function disrupted due to ambiguous etiology.…”