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Feasibility and diagnostic accuracy of early mood screening to diagnose persisting clinical depression/anxiety disorder after stroke.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Lees, Rosalind Stott, David J. Quinn, Terence J. Broomfield, Niall M.
Description	Country affiliation: United kingdom Author Affiliation: Lees R ( Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.)
Abstract	BACKGROUND: Depression/anxiety disorders are common after stroke and have a negative impact on outcomes. Guidelines recommend that all stroke survivors are screened for these problems. However, there is no consensus on timing or method of assessment. We investigated the feasibility and accuracy of a very early screening strategy and the diagnostic accuracy this has for depression/anxiety disorders at 1 month. METHODS: Screening tools were Hospital Anxiety and Depression Scale (HADS) and Depression Intensity Scale Circles (DISCs); we also assessed cognition using the Montreal Cognitive Assessment (MoCA). Screening was offered to sequential stroke admissions. At 1 month we assessed for clinical depression/anxiety disorder using Mini-International Neuropsychiatric Interview (MINI) and retested screening tools. We described test accuracy of acute depression/anxiety screening for clinical diagnosis of depression/anxiety disorder at 1 month and described temporal change in screening test scores. We assessed feasibility by describing proportions that were able, agreed to and completed the screening tests. RESULTS: Over 4 months, 102/146 admissions were suitable for screening following initial medical assessment, 69 (68%) agreed to screening, of whom 33 (48%) required researcher assistance to complete the screening test battery. Median time to assessment was 2 days (IQR: 1-4). Early HADS suggested n = 9 (13%) with depression; DISCs n = 25 (37%). Median acute MoCA was 21/30. At 1 month, n = 61 (88%) provided data. Repeat scores showed improvement over time; HADS (anxiety) mean difference: 2.5 (95% CI: 1.2-3.7), HADS (depression) mean difference: 1.6 (95% CI: 0.3-2.9). MINI defined n = 12 (20%) with depression and n = 6 (10%) with anxiety disorder. Comparing baseline screening to 1-month clinical diagnosis, HADS sensitivity was 0.25 (95% CI: 0.09-0.53) and specificity 0.94 (95% CI: 0.84-0.98); DISCs sensitivity was 0.92 (95% CI: 0.65-0.99) and specificity 0.78 (95% CI: 0.64-0.87). CONCLUSIONS: Even amongst 'medically stable' stroke patients, depression/anxiety screening at the acute stage may not be feasible or accurate. Half of participants required assistance from the researcher to complete assessments. The poor predictive accuracy of HADS for depression/anxiety disorder at 1 month may be due in part to the high prevalence of cognitive impairment in our sample. Screening in the first few days after stroke does not appear useful for detecting clinically important and sustained depression/anxiety problems.
File Format	HTM / HTML
ISSN	10159770
e-ISSN	14219786
Journal	Cerebrovascular Diseases
Issue Number	5
Volume Number	37
Language	English
Publisher	Karger
Publisher Date	2014-01-01
Publisher Place	Switzerland
Access Restriction	Open
Subject Keyword	Discipline Vascular Diseases Discipline Cardiology Physiology Anxiety Disorders Diagnosis Depression Psychology Depressive Disorder Early Diagnosis Stroke Complications Adolescent Etiology Cognition Disorders Feasibility Studies Psychiatric Status Rating Scales Sensitivity And Specificity Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Neurology Neurology (clinical) Cardiology and Cardiovascular Medicine

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