Screening for depression in post stroke patients.
BACKGROUND
depression has a significant prevalence in patients following a stroke. Studies have found rates to be between 25-54%.


OBJECTIVE
Within this audit we aimed to ascertain the proportion of patients who have been identified as having depression, and explore the methods employed to identify depressed patients. We also looked to assess the number of these patients who have been treated for depression and to explore the medications used for the treatment of depression.


METHODS
this audit was conducted in two phases. Initially an audit was conducted to establish the current prevalence, screening and management of depression in post-stroke patients. Following this, we introduced the PHQ-9 as a screening tool for depression and a re-audited at four months. In phase 2, All patients admitted to the stoke ward in Bedford hospital between 10/9/09 and 13/12/09 were included in the audit. Patients were screened for depression using the PHQ-9 questionnaire two weeks after admission.


RESULTS
the incidence of depression within the phase one group was 28%. In 9 of these cases there was no record of mood assessment or diagnosis of depression in the medical notes. Thirteen out of 60 patients were prescribed psychotropic agents during their stay. In phase 2, Of the 18 patients screened, 10 patients (56%) scored 5 or above, which according to the scoring system of the PHQ-9 is indicative of depression. One patient scored 10 indicative of moderate depression and one patient scored 19 indicative of moderately severe depression.


CONCLUSIONS
phase 1 of this audit revealed that there was no formal screening tool in use to identify depression in post stroke patients. Consequently we found the prevalence to be 28%. This correlates with the lower end of the rate expected within this group according to the literature. As no screening tool was being used, practice was not in accordance with the standards set by NICE guidelines. This led us to introduce the PHQ-9 screening tool in phase 2. Following this, we found the prevalence of depression had increased from 28% to 56%.


CONCLUSIONS
these results highlight the importance of formal screening in order to reliably identify patients who have signs of depression.
South Essex University Partnership NHS Trust, UK.
Sophia Ul
SU
Haq
Christopher
C
Symeon
Mark
M
Agius
Roseanna
R
Brady
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004739:England; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008485:Medical Audit; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D008875:Middle Aged; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D020521:Stroke / Q000453:epidemiology / Q000523:psychology*; D014600:Utilization Review
D000928:Antidepressive Agents