Screening For Poststroke Depression Research Articles

Abstract NS1: Depression Vs Psychiatry Appointments Post Stroke Discharge Phone Call

Background: Post-stroke depression (PSD) affects up to one-third of stroke survivors and remains under-recognized. The optimal time for PSD screening seems to be about 30-45 days post-stroke. However, screening and follow up remains insufficient. Methods: Our stroke certified registered nurse contacted stroke patients admitted to Kaiser Permanente Los Angeles in 2021 to assess depression within 30-45 days post discharge using the Patient Health Questionnaire Screening Tool (PHQ9). Two call attempts were made. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored10-19 were referred to depression care management (DCM), while 20 and above were referred to psychiatry directly. We collected the demographics, stroke types and discharge disposition inpatients who were lost to follow up and patients who completed the follow up. Data were analyzed using R-Statistics. Results: Among 92 patients, 41 (45%) had follow-up depression screening completed; 13 (32%)received psychiatry referral given severity of depression, and 28 (68%) received a depression care management referral. Of 51 patients who did not complete follow-up screening, 27 (53%)declined to participate in screening, while 22 (43%) could not be reached. Patients who did not receive follow-up screening were older (P=0.02). Race, gender, discharge mRS or length of acute hospital stay did not have a significant effect on patient’s depression screening follow-up status. Patients discharged home with home health showed a trend for better completed follow-ups despite not reaching statistical significance (P=0.07). Conclusion: Raising awareness about the necessity of depression screening and its treatment is of utmost importance for reaching optimal recovery and rehabilitation potential in stroke patients. Post-discharge follow-up and education can be implemented to narrow the PSD recognition gap.

Abstract TP23: Depression: An Aftermath Of Stroke

Background: As the leading cause of disability, stroke compromises physical and mental health. Stroke survivors are distressed by social challenges and emotional health problems. Many stroke survivors struggle with mental health, even with symptom resolution or returning to physical baseline. The feelings of anger, frustration, fear, and hopelessness are common emotions experienced. The sudden nature of this condition brings an overwhelming strain that significantly impacts patients’ lives. Objectives: To screen for post-stroke depression (PSD) in the inpatient setting and examine the feasibility of a nurse-led structured depression screening and early referral based on severity compared to care-as-usual. Neuman’s system model and the Iowa model of evidence-practice complemented the scholarly project by looking at patients holistically with a goal of improving their outcomes. Methods: We included two groups: a care-as-usual cohort of discharged stroke patients compared to patients screened for depression within 48 hours of admission for stroke. The Patient Health Questionnaire-9 (PHQ-9) instrument was used to screen stroke patients admitted to the hospital. Patients in the screening group were referred to the organization’s Center for Healthy Living, Depression Care Management, Social Services, and Behavioral Health Management prior to discharge. Descriptive statistics were utilized for data analysis. Results: There were 43 patients in the sample, 17 in the screening group and 26 in the care-as-usual group. Depression scores for the screening group had a mean of M = 5.7 (range 1-27). The care-as-usual group had a mean of M = 49.3 days to depression screening. Of the 43 participants, 12 (27.9%) were depressed; 7 (26.9%) in the usual care group versus 5 (29.4%) in the screening group. Conclusion: Establishing the nurse-led PSD screening protocol was feasible for identifying depression among stroke survivors within 48 hours of admission. Research is needed to establish whether the protocol can improve early referral, long-term health outcomes, and quality of care. Recognition of depression in the population of stroke patients may support patients with PSD and facilitate early management of mental health needs.

Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study

BackgroundStroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke.MethodA hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients’ interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association.ResultA total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06–5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94–17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04–17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000).ConclusionImportant factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.

Association of post-stroke-depression and health-related quality of life three months after the stroke event. Results from the Stroke Cohort Augsburg (SCHANA) study

ABSTRACT Approximately one-third of patients with stroke show depressive symptoms. The so-called post-stroke depression (PSD) has a negative influence on mortality as well as physical and mental conditions. The aim of this study was to analyse the association between PSD and health-related quality of life (HRQOL) in patients with stroke. The analysis was based on data of 326 patients from the Stroke Cohort Augsburg (SCHANA Study) collected after the stroke event by interview and three months later using a postal survey. Depressive symptoms were measured with the Patient-Health Questionnaire (PHQ-9), subjective health status with the EuroQol 5D visual analogue scale (EQ-5D VAS), and HRQOL with the Stroke Impact Scale (SIS). Patients with depressive symptoms were compared to those without depressive symptoms in terms of sociodemographic characteristics and scores of the SIS and the EQ-5D VAS. Multiple linear regression models were calculated to investigate the association between PSD and subjective health status and HRQOL. Three months after the stroke, 17.8% of patients had depressive symptoms. Patients with PSD showed significantly worse SIS and EQ-5D VAS scores. In addition, an independent negative linear association between PSD and subjective health status and between PSD and all domains of SIS could be found. The study confirmed that PSD is common in patients with mild stroke and negatively related to all stroke-specific HRQOL domains. The results underline the importance of early screening for PSD in stroke patients since it may hinder a successful rehabilitation.

Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients.

Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.

Higher Serum Lactic Dehydrogenase is Associated with Post-Stroke Depression at Discharge.

PurposePost-stroke depression (PSD) is one of the most common and severe psychological sequelae after stroke, negatively affecting the patient’s functional outcome and quality of life. Rapidly measurable biomarkers to predict PSD are pivotal for the optimized care and allocation of healthcare resources. Lactic dehydrogenase (LDH) levels are increased in patients with central nervous system (CNS) disorders such as cerebral infarction and hypoxic–ischemic encephalopathy, which may be related to the occurrence of PSD in acute ischemic stroke (AIS) patients. This study aimed to investigate whether LDH levels on admission are associated with PSD at discharge.Patients and MethodsA multicenter prospective cohort study was conducted, including all consecutive AIS patients within 7 days after symptom onset from May 2018 to October 2019. According to the distribution of LDH and the number of patients, patients were divided into equal tertiles. PSD was evaluated by DSM-V criteria and the 17-item Hamilton Rating Scale for Depression (HRSD-17) at discharge.ResultsA total of 518 AIS patients were included. The optimal cut-off points of LDH were: lowest tertile (T1) 102–159/L, middle tertile (T2) 160–189 U/L, and upper tertile (T3) 190–520 U/L. A total of 249 patients (48.07%) were diagnosed with PSD at discharge. After adjusting for potential confounding factors, the odds ratio of T3 PSD was 1.698 (95% CI, 1.070–2.694, P=0.025), compared with T1.ConclusionIn summary, LDH serum levels on admission are associated with PSD at discharge. Clinicians should pay more attention to the baseline LDH level in screening for PSD at discharge.

Patient Health Questionnaire-9 predicts the functional outcome of stroke patients in convalescent rehabilitation ward.

IntroductionPoststroke depression (PSD) negatively affects the functional outcome of stroke patients. Patient Health Questionnaire‐9 (PHQ‐9) is a validated screening tool for detecting PSD. This study investigated the relationship between PHQ‐9 score and functional outcomes in stroke patients in a convalescent rehabilitation ward by evaluating functional independence measure (FIM) gain scores and the proportion of patients discharged.MethodsIn this retrospective study conducted from January 2017 to September 2019, consecutive stroke patients who were admitted to the convalescent rehabilitation ward and could answer PHQ‐9 were assessed. The association between PHQ‐9 scores at the time of admission to the convalescent rehabilitation ward and outcomes (FIM gain score and the proportion of patients discharged) was statistically analyzed.ResultsAmong the 215 patients enrolled in the study, 62 (28.8%) were assessed as having depression, in whom PHQ‐9 scores were 5 or above. Multivariate analysis revealed that the PHQ‐9 score on admission to the convalescent rehabilitation ward was a significant independent factor influencing the FIM gain score (p = .009). In addition, a multivariate analysis revealed that the PHQ‐9 score at the time of admission to the convalescent rehabilitation ward was a significant independent factor influencing the inability to discharge a patient (odds ratio 1.24, 95% confidence interval 1.12–1.39, p < .001).ConclusionsThe PHQ‐9 score is a useful tool for predicting patient functional outcome, admission to the facility, and screening for poststroke depression.

The validity and reliability of the PHQ-9 in screening for post-stroke depression

BackgroundDepression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients.MethodsThe objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks–2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed.ResultsIn all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach’s alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78–0.96).ConclusionsThe Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.

Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores.

Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke. The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke. Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7-30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24). The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach's alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5-25.5, moderate PSD = 25.5-45.5, high PSD ≥ 45.5. ESM-PSD cutoff scores show the expected correspondence with mild-moderate-severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.

Post-stroke depression screening using the depression intensity scales circles in the UAE

Post-stroke depression screening using the depression intensity scales circles in the UAE

Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression.

Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.

Abstract WP409: Heterogeneous Patterns of Depressive Symptoms Among Stroke Survivors: Implications for Screening

Introduction: Although routine screening for post-stroke depression is recommended by the AHA/ASA, the optimal screening method remains unclear. A high rate of false-positives is a potential issue of existing screening tools, as indicated in a recent meta-analysis. This study aims to examine patterns of depressive symptoms that may provide information to improve screening accuracy. Methods: The study sample consists of 613 first-ever stroke patients from the Brain Attack Surveillance in Corpus Christi project (2011-2015), a population-based stroke surveillance study. Depressive symptoms at 90 days after stroke were assessed by the 8-item Patient Health Questionnaire (PHQ-8). Symptom patterns were identified using latent class analysis. Depression status (PHQ-8≥10) by class was examined. Results: The sample was mainly composed of non-Hispanic Whites (38.3%) and Mexican Americans (57.3%), and equally distributed by sex. Mean age was 65.7 (SD=11.0). Prevalence of depression was 26.6% at 90 days after stroke. The best-fitting model yielded 4 classes (Figure). Notably, one class was characterized by symptoms that often overlap between depression and stroke, as opposed to psychological symptoms (termed overlapping symptom class). Percentages of participants classified as having depression were 84.1% in the psychological symptom class, 100.0% in the high-risk class, and 51.7% in the overlapping symptom class. The overlapping symptom class accounted for 28.8% of participants classified as having depression. Conclusion: Existing depression screening tools developed in non-stroke populations may have poor test characteristics in individuals with stroke. Additional research is needed to develop highly sensitive and specific screening tools to identify individuals with post-stroke depression in need of further evaluation and treatment. Understanding symptom patterns may increase our ability to personalize treatment for individual stroke survivors.

Abstract 118: Predictors of Post-Stroke Depression in Ischemic Stroke Patients using the Patient Health Questionnaire-9

Introduction: Post-stroke depression (PSD), which affects one-third of stroke patients, is an important psychosocial consequence after stroke linked with higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct when to screen for PSD. Using hospital and clinic PSD screening, we sought to identify predictors of PSD symptoms, factors associated with worsening PSD symptoms, and use of antidepressants in PSD. Methods: In a retrospective review of patients hospitalized with ischemic stroke from 01/2014-11/2016, patients completed a Patient Health Questionnaire-9 (PHQ-9) inpatient and again in clinic follow-up within 180 days (median 45 days). PHQ-9 score was categorized as no symptoms (0-4), mild (5-9), moderate (10-14) and severe (15-27). Baseline and follow-up data were analyzed by t-test and Fisher’s exact test for univariate analyses and logistic regression model for multivariable analyses. Results: Among 201 patients, depressive symptoms (PHQ-9 &gt; 4) were seen in 30% of patients during hospitalization and 46% in clinic (54% of which had no symptoms inpatient). At follow-up, 64% of patients had stable/improved symptoms and 36% were worse by PHQ-9 category. In univariate analysis, clinic modified Rankin Scale (mRS) ≥2 (p=0.027) and clinic antidepressant prescription (p=0.0004) were associated with worsening PHQ-9 category. In logistic regression analysis, mRS ≥2 (p=0.022), posterior circulation stroke (p=0.029), and clinic antidepressant prescription (p=0.002) were associated with worsening. Conclusions: A substantial number of ischemic stroke patients develop or have worsening depression from hospitalization to follow-up. Post-stroke disability (mRs ≥2) and posterior circulation stroke were associated with worsening depression at follow-up. Worsening symptoms prompted a change in management in our clinic. Screening for PSD inpatient should be followed-up in clinic as both may impact treatment and outcomes.

Screening for Post-Stroke Depression and Cognitive Impairment at Baseline Predicts Long-Term Patient-Centered Outcomes After Stroke.

Independence and reintegration into community roles are important patient-centered outcomes after stroke. Depression and cognitive impairment are common post-stroke conditions that may impair long-term function even years after a stroke. However, screening for these post-stroke comorbidities remains infrequent in stroke prevention clinics and the utility of this screening for predicting long-term higher-level function has not been evaluated. To evaluate the ability of a validated brief Depression, Obstructive sleep apnea, and Cognitive impairment screen (DOC screen) to predict long-term (2-3 years after stroke) community participation and independence in instrumental activities of daily living post stroke. One hundred twenty-four patients (mean age, 66.3 [standard deviation = 15.7], 52.4% male) completed baseline depression and cognitive impairment screening at first stroke clinic visit, and telephone interviews 2 to 3 years post stroke to assess community independence (Frenchay Activities Index [FAI]) and participation (Reintegration to Normal Living Index [RNLI]). A subset of these patients also consented to complete detailed neuropsychological testing at baseline. Univariate and multivariate linear (FAI) and logistic (RNLI) regression analyses were used to determine the individual relationship between baseline data (predictors) and follow-up scores. Older age (β = -0.17, P = .001), greater stroke severity (β = 1.84, P = .015), more depressive (β = -2.41, P = .023), and cognitive (β = -2.15, P = .046) symptoms independently predicted poor instrumental activity ( R2 = .27; P < .001). Measures of executive dysfunction were the strongest correlates of poor instrumental activity. Higher depression risk was the only significant predictor of participation on the RNLI in regression modeling (odds ratio = 0.46, P = .028). Baseline DOC screening in stroke prevention clinics shows that symptoms of depression and cognitive impairment are independent predictors of impaired higher-level functioning and community reintegration 2 to 3 years after stroke. Novel rehabilitation and psychological interventions targeting people with these conditions are needed to improve long-term patient-centered outcomes.

Screening Adherence for Depression Post Stroke: Evaluation of Outpatients, a London Experience (SAD PEOPLE)

ABSTRACTBackground: Post stroke depression (PSD) is common, and the transition home following discharge may be especially challenging for stroke survivors.Objectives: This study aimed to determine how well specific Canadian Best Practice Recommendations for PSD screening were adopted within a stroke rehabilitation outpatient clinic before and after the utilization of a standardized clinical form.Methods: Practices were evaluated through retrospective chart review before and after the implementation of the standardized form which cued physicians to administer the Patient Health Questionnaire 9 (PHQ-9) at the first outpatient visit. Participants included those aged ≥18 years with a primary diagnosis of stroke.Results: One hundred thirty-five subjects’ charts were reviewed. Form implementation was associated with increased rates of PSD screening (93.8% versus 0%) and charting regarding mood (55.4% versus 15.7%).Conclusion: This study highlights the frequency of depressive symptoms in an outpatient cohort and demonstrates how screening rates can be improved by using a standardized form. Routine PHQ-9 completion at the first outpatient visit was associated with more physician–patient discussion and documentation regarding mood.

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study

IntroductionThis is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms.MethodsGroups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale.ResultsAt 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61).LimitationsThe use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results.Conclusions(1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients’ mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

High patient participation rate in Post-Stroke Depression screening at an Acute Stroke Center (P4.168)

High patient participation rate in Post-Stroke Depression screening at an Acute Stroke Center (P4.168)

Poststroke Depression Screening: An Executive Summary.

Poststroke Depression Screening: An Executive Summary.

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

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.

Screening for Depression After Stroke: Occupational Therapists' Performance to Protocols

The ability of occupational therapists to enact post-stroke depression screening protocols was considered. The medical notes of 12 patients admitted to an in-patient stroke unit over a 3-month period were consulted to assess timely, appropriate administration, interpretation, and recording of the results of administering the protocols. Post-stroke depression screening by occupational therapists occurred for 83% of patients. Of the screens conducted, all of the patients were administered the correct tool. In 100% of cases screened, the outcome was recorded and in at least 80% clinicians had provided feedback to the patient on the results of the screen.