Screening for depression in stroke: relationship to rehabilitation efficiency

Depression is common after stroke but is often not diagnosed. Its presence may impair progress during rehabilitation and limit functional improvement after discharge. We investigated the use of the Geriatric Depression Scale (GDS) to screen for depression among acute stroke patients. All stroke patients in an acute rehabilitation hospital who were referred for assessment of cognitive deficits were also screened for depression with the GDS. By using a modified cutoff score to account for items that could reflect physical effects of the stroke rather than depression, 22% of patients screened were classified as depressed. The rate of depression was higher among women (36%) than men (10%). Patients with elevated GDS scores (> or =15) stayed in the hospital an average of 5.76 days longer than patients whose scores fell below this cut-off. Higher GDS scores were also associated with less efficient use of rehabilitation services as measured by the Functional Independence Measure. Screening stroke patients for depression at the time of admission to rehabilitation may identify individuals at risk to progress more slowly, may initiate more comprehensive assessment, and, if appropriate, may initiate rapid intervention.