Comparative validity of depression assessment scales for screening poststroke depression

Area of Science:

• Neurology
• Psychiatry
• Clinical Assessment

Background:

• Post-stroke depression (PSD) is a common complication affecting patient recovery.
• Accurate screening for PSD is crucial for timely intervention.
• Existing screening tools may have varying performance and misclassification factors.

Purpose of the Study:

• To compare the screening performance of four common scales for PSD at 2 weeks and 1 year post-stroke.
• To identify factors contributing to misclassification of PSD by these scales.
• To inform the selection of appropriate screening tools in clinical practice.

Main Methods:

• A cohort of 423 stroke patients were assessed at 2 weeks, with 288 followed up at 1 year.
• Diagnosis of major and minor PSD was based on DSM-IV criteria.
• Screening scales included Beck Depression Inventory (BDI), HADS-D, HAMD, and MADRS.
• Receiver operating characteristic (ROC) analysis evaluated scale sensitivity and specificity.

Main Results:

• All scales demonstrated good discriminating ability for major and all PSD at both time points (AUCs 0.88-0.96).
• Misclassification was influenced by demographics and stroke severity, particularly for BDI and HAMD.
• Misclassification was more pronounced for all PSD compared to major PSD, and at 2 weeks versus 1 year post-stroke.

Conclusions:

• No significant differences in overall screening ability for PSD were observed among the scales.
• Factors influencing misclassification varied between scales, especially in the acute phase.
• Scales with fewer somatic items may be preferable for screening PSD, particularly early after stroke.