Post-stroke depression in a sub-Saharan Africans: Validation of the Japanese Stroke Scale for Depression

Abstract

Background: Japanese Stroke Scale for Depression (JSS-D) is not a validated instrument for post stroke depression (PSD) in sub-Saharan Africans. Methods: Ninety-two subjects on follow-up in a stroke clinic were consecutively assessed for demographic and clinical variables, and all were subsequently assessed for depression with the JSS-D. Functional ability was assessed with Rankin score and good functional recovery was defined as Rankin score of ≤2. Stroke type was determined using cranial computed tomography or magnetic resonance imaging as cerebral infarct or intracerebral hemorrhage. Data was compared between subjects with and without PSD. Symmetric agreement between JSS-D and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) criteria for depression was compared on Cohen's kappa statistics and the sensitivity, specificity of JSS-D was tested on a receiver operated characteristics (ROC) curve. Results: PSD occurred in 17 (18.5%) of study subjects. Mean age was not significantly different between PSD and no PSD, P = 0.226, but there was a difference in the sex distribution (P = 0.034) with a male sex preponderance for both groups. Rankin score was higher in PSD and significantly different both at discharge and the time of evaluation (P = 0.019 and 0.003). JSS-D agreed with DSM IV criteria for mild depression significantly on Cohen's kappa statistics, kappa = 0.69, P < 0.0001. The sensitivity and specificity of JSS-D on ROC curve were 94.1% and 97.2% respectively at a JSS-D cut-off value of 2.37, area under the curve = 0.99, P = < 0.0001. Conclusion: JSS-D could be used for PSD with acceptable sensitivity and specificity in sub-Saharan Africans.