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Validating screening tools for depression in stroke and transient ischemic attack patients.

Joey C Prisnie1, Kirsten M Fiest2, Shelagh B Coutts3

  • 1Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada.

International Journal of Psychiatry in Medicine
|June 11, 2016
PubMed
Summary

The Patient Health Questionnaire (PHQ)-2 and PHQ-9 are effective tools for screening depression in stroke patients. These brief questionnaires demonstrate good sensitivity and specificity, making them suitable for clinical use.

Keywords:
GDS-15HADS-DPHQ-9accuracymental healthvalidation

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Area of Science:

  • Neurology
  • Psychiatry
  • Clinical Psychology

Background:

  • Post-stroke depression is a common complication affecting patient recovery.
  • Accurate and efficient screening tools are needed to identify depression in stroke survivors.
  • Current validation of depression screening tools in stroke populations is limited.

Purpose of the Study:

  • To validate four commonly used depression screening tools in patients with stroke and transient ischemic attack (TIA).
  • To determine the optimal cut-points for sensitivity and specificity of each tool.
  • To compare the performance of PHQ-9, PHQ-2, HADS-D, and GDS-15 in a post-stroke population.

Main Methods:

  • A cohort of 122 stroke and TIA patients completed the PHQ-9, PHQ-2, HADS-D, and GDS-15.
  • Diagnosis of major depression was established using the Structured Clinical Interview for DSM-IV (SCID).
  • Receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-points and assess diagnostic accuracy.

Main Results:

  • The prevalence of major depression was 9.8% among the study participants.
  • The PHQ-9 achieved 81.8% sensitivity and 97.1% specificity, with an area under the ROC curve (AUC) of 86.6%.
  • The PHQ-2 demonstrated 75.0% sensitivity and 96.3% specificity (AUC: 86.7%), outperforming the GDS-15 (AUC: 66.3%) and performing comparably to the HADS-D (AUC: 85.9%).

Conclusions:

  • The PHQ-2 and PHQ-9 are validated as suitable, time-efficient depression screening tools for stroke and TIA patients.
  • The Hospital Anxiety and Depression Scale (HADS-D) offers no apparent advantage over PHQ-based scales in this population.
  • The Geriatric Depression Scale (GDS-15) is not recommended for general use in stroke clinics due to its lower sensitivity and discriminative ability.