Potential screening measures for depression and anxiety after stroke

Abstract

Depression and anxiety are common problems after stroke. The National Clinical Guidelines for stroke (Royal College Physicians, 2004) recommend that all patients are screened for low mood. The aim of the review was to identify measures which could be used for this purpose and to review the evidence for their sensitivity and specificity with stroke patients. A literature search was conducted using electronic databases, including Medline, Embase, PsycInfo and CINAHL, to identify articles published in peer reviewed journals on mood assessment after stroke. Questionnaire measures were identified which were appropriate only for those able to communicate verbally. In addition visual analogue and observer rating scales were identified which were considered appropriate for all stroke patients. The hospital anxiety and depression scale (HADS) and general health questionnaire (GHQ) had most evidence to support their use as screening measures for people without communication problems. The stroke aphasic depression questionnaire–hospital version (SADQ-H) had best support for use as a screening measure for those with communication problems. No measures were identified that had been validated as screening measures for anxiety after stroke. The HADS, GHQ12 and SADQ-H10 were recommended as short screening measures suitable for detecting depression after stroke. However the cut-offs giving good sensitivity and specificity were not well established for stroke patients and measures need to be developed for detecting anxiety.

Depression Screening in Stroke

“…However, the DT demonstrated the lowest AUC of all measures. It did not demonstrate a sensitivity-specificity combination that met with guidelines for a good depression screening tool 21 and had the weakest correlations with the other scales. Although factor analysis of the K-10 has identified a depression specific factor, 35 the DT addresses global distress in a single item, potentially capturing a range of nondepressive states of emotional distress (reducing sensitivity).…”

“…16 -20 Several other depression measures commonly used in stroke practice (eg, Geriatric Depression Scale) also have evidence supporting their use. 21 Evidence for diagnostic accuracy of the BDI-II, DT, and K-10 is lacking in stroke populations. Diagnostic accuracy of the original BDI has been evaluated, 18,[22][23][24] BDI-II, 12 although a factor analytic study in a neurorehabilitation population indicated the measure provides a meaningful severity score of depression in patients with stroke.…”

“…The 2 ideal cutoff options displayed in Table 2 are those meeting criteria for a good screening tool (sensitivity Ն0.80 and specificity Ն0.60) 21 and those with highest sum of sensitivity and specificity. The PHQ-9 categorical diagnosis of "major depressive syndrome" derived from the diagnostic algorithm had high specificity but poor sensitivity.…”

“…8,9,21,38 However, the PHQ-9 diagnostic algorithm (providing a categorical diagnosis of major depressive syndrome) had high specificity but unacceptably low sensitivity and cannot be recommended. In a stroke population, it can be argued that screening should optimize detection of major depression cases by using assessments with maximum sensitivity because the clearly outlined negative effects of depression outweigh the consequences of conducting further assessments on patients with no depression.…”

“…*Previously recommended cutoff. †Cutoff best meeting criteria for a "good" screening tool 21 (none available for DT). ‡Highest sum of specificity and sensitivity.…”