Detecting psychiatric morbidity after stroke: comparison of the GHQ and the HAD Scale

Mood disorders are common after stroke and may impede physical, functional, and cognitive recovery, making early identification and treatment of potential importance. We aimed to compare the accuracy of the General Health Questionnaire (GHQ-30) and the Hospital Anxiety and Depression (HAD) Scale in detecting psychiatric morbidity after stroke and to determine the most suitable cutoff points for different purposes.

One hundred five hospital-referred stroke patients completed both the GHQ-30 and HAD Scale 6 months after onset before a blinded psychiatric assessment in which the Schedule for Affective Disorders and Schizophrenia with some supplementary questions was used to determine a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis. Measures were compared in terms of sensitivity, specificity, and receiver operating characteristic curves.

No significant differences were found between the GHQ-30 and the HAD Scale in identifying those patients with any DSM-IV diagnosis (P=0.95), grouped depression (P=0.56), or anxiety (P=0.25) disorders. The previously recommended cutoff points for identifying "cases" for the GHQ (4/5) and for the HAD Scale (8/9 and 11/12) were found to be suboptimal in this population.

The GHQ-30 and HAD scale exhibited similar levels of sensitivity and specificity. Data are presented, taking into account the "cost" of false-positives and negatives, to allow a choice of cutoff points suitable for differing situations.