Abstract T P287: The Utility of Depression Screening in the Acute Stroke Hospitalization

Abstract

Background: The importance of early recognition and treatment of post stroke depression (PSD) has led to recommendations for depression screening during the acute stroke admission. We studied the utility of PSD screening during acute stroke admissions using the 2-item Patient Health Questionnaire (PHQ-2) by (a) determining the prevalence of positive depression screen during admission and (b) calculating the level of agreement between positive screens during admission and outpatient follow-up. Methods: This was a retrospective cohort study of adult patients discharged 1/2013 - 12/2013 with principal discharge diagnosis of acute ischemic stroke or intracerebral hemorrhage excluding patients who died during admission. PSD screening was systematically performed using the 4-item PHQ (PHQ-4) administered to patients on the stroke service by midlevel providers. Positive screen was defined as PHQ-2 subscore ≥3. At outpatient follow up, the 9-item PHQ (PHQ-9) was administered by patient questionnaire. Results: Of 718 patients, acute phase PHQ-4 data was available for 50% (358), 14% were not assessed due to drowsiness or aphasia, 2% were both admitted and discharged on weekends, and 21% were admitted to non-stroke services. Demographic characteristics were similar between the groups with and without PHQ data with higher rates of hemorrhagic strokes, longer ICU stay, and worse discharge mRS in the group without PHQ data. The median time from admission to PHQ-4 was 3 days. The screen was positive in 4.7% (17/358, 95% CI 2.8% - 7.5%). Outpatient follow-up occurred in 55% (396/718) patients a median of 34 days postdischarge and 260 had PHQ-9 data. Of these, 20.8% (54/260, 95% CI 16.0% - 26.2%) screened positive using PHQ-2. There were 158 patients who had PHQ-2 data from both acute and follow up phases, 1.9% (3/158) of these screened positive in the acute phase and an additional 15.8% (25/158) who screened negative in the acute phase converted to positive at follow up. Conclusion: Systematic screening for PSD using PHQ-2 in acute phase of stroke identified few patients with depression and there was subsequent conversion to a positive screen at follow up. PSD screening in acute in-hospital phase does not appear to be cost efficient utilization of inpatient resources.