Screening instruments for depression and anxiety following stroke: experience in the Perth community stroke study

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Psychology

Background:

• Stroke is a major cause of disability, often leading to secondary depression and anxiety.
• Accurate screening for these conditions is crucial for timely intervention and improved patient outcomes.
• Existing screening tools require validation in specific post-stroke populations.

Purpose of the Study:

• To evaluate the relative efficacy of three screening instruments for depression and anxiety in stroke patients.
• To determine the sensitivity and specificity of the Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS), and General Health Questionnaire (GHQ)-28.
• To assess diagnostic accuracy according to DSM-III criteria 4 months post-stroke.

Main Methods:

• The Perth Community Stroke Study collected data on stroke patients.
• Three instruments (HADS, GDS, GHQ-28) were used for screening.
• Screening results were compared against DSM-III diagnoses for depression and anxiety disorders.

Main Results:

• The GHQ-28 and GDS demonstrated satisfactory performance for screening depression, with GHQ-28 showing overall superiority.
• The HADS depression scale was not satisfactory for depression screening.
• All three scales performed poorly in screening for anxiety disorders post-stroke.
• HADS anxiety had high sensitivity but low specificity and positive predictive values.

Conclusions:

• GHQ-28 and GDS are recommended as suitable screening tools for depression in stroke patients.
• Current screening tools are inadequate for identifying anxiety disorders in this population.
• Further research is needed to develop and validate effective anxiety screening instruments for post-stroke care.