title: Depression and anxiety screening after stroke: adherence to guidelines and future directions.
abstract: OBJECTIVE
  This article examines practical approaches to increasing rates of screening for depression and anxiety in hospital-based stroke services.
  
  
  METHODS
  The literature on depression and anxiety following stroke is briefly reviewed together with evidence relating to screening. A small-scale trial of an educational and support package to improve screening rates compared 30 consecutive admissions before and after the intervention. An extended commentary on the outcome considered alternative approaches to improving screening.
  
  
  RESULTS
  The literature review confirmed that depression after stroke has multiple adverse effects and that screening is not universally applied. There has been less research into anxiety after stroke, but it is likely that anxiety screening is also incomplete. The trial of the intervention to promote screening demonstrated strong trends towards improvement for depression (23.3%; odds ratio 2.67; χ(2) p = 0.067) and a trend for anxiety (16.7%; odds ratio 1.96; χ(2) p = 0.20).
  
  
  CONCLUSIONS
  Education and training about depression and anxiety screening and access to screening materials improved rates of screening to a limited degree. An extended commentary explored how screening rates might be further improved by considering the intervention strategy, the staffing model, the training approach and the screening methods themselves. Finally, consideration is given to treatment approaches for mood disorders.
authors: Cardiff University /Cardiff and Vale University Health Board, Clinical Psychology Training, Archway House, Llanishen, Cardiff, UK. reg.morris@wales.nhs.uk
authors: Reg
authors: R
authors: Morris
authors: Jimmy
authors: J
authors: Jones
authors: Julie
authors: J
authors: Wilcox
authors: Samantha
authors: S
authors: Cole
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005544:Forecasting; D019983:Guideline Adherence; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D020521:Stroke / Q000150:complications / Q000523:psychology*