Article2012

Depression Screening in Stroke

Alyna Turner · John A. Hambridge · Jennifer Helen White · Gregory Leigh Carter · Kerrie Ann Clover · Louise Nelson +1 more

114 citations0/0 files storedStroke

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Stroke Rehabilitation and Recovery Mental Health Treatment and Access

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.

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References

1983The Hospital Anxiety and Depression Scale 2001The PHQ-9 2002Short screening scales to monitor population prevalences and trends in non-specific psychological distress 2003The Patient Health Questionnaire-2 2003Screening for Serious Mental Illness in the General Population 2008National Survey of Mental Health and Wellbeing: Summary of Results 2009Screening for anxiety and depression after stroke: Comparison of the Hospital Anxiety and Depression Scale and the Montgomery and Åsberg Depression Rating Scale 1995Screening instruments for depression and anxiety following stroke: experience in the Perth community stroke study

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2017Evaluation of the Hospital Anxiety and Depression Scale (HADS) in screening stroke patients for symptoms: Item Response Theory (IRT) analysis 2017Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? A systematic review and meta-analysis 2021Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire‐9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta‐analysis

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