title: Depression screening in stroke: a comparison of alternative measures with the structured diagnostic interview for the diagnostic and statistical manual of mental disorders, fourth edition (major depressive episode) as criterion standard.
abstract: OBJECTIVE
  Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard.
  
  
  METHODS
  Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures.
  
  
  RESULTS
  Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78-0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69-0.89) for the Kessler-10 to 0.89 (0.79-0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61-0.83), significantly smaller than the Beck Depression Inventory-II (P<0.05).
  
  
  CONCLUSIONS
  Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.
authors.affiliation: Senior Research Fellow, Heart Research Centre, Box 2137 Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia. alyna.turner@heartresearchcentre.org
authors.forename: Alyna
authors.initials: A
authors.lastname: Turner
authors.forename: John
authors.initials: J
authors.lastname: Hambridge
authors.forename: Jennifer
authors.initials: J
authors.lastname: White
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.forename: Kerrie
authors.initials: K
authors.lastname: Clover
authors.forename: Louise
authors.initials: L
authors.lastname: Nelson
authors.forename: Maree
authors.initials: M
authors.lastname: Hackett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods / Q000592:standards*; D008297:Male; D008370:Manuals as Topic; D001523:Mental Disorders / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards*