Validating screening tools for depression in stroke and transient ischemic attack patients.
The best screening questionnaires for detecting post-stroke depression have not been identified. We aimed to validate four commonly used depression screening tools in stroke and transient ischemic attack patients.



Consecutive stroke and transient ischemic attack patients visiting an outpatient stroke clinic in Calgary, Alberta (Canada) completed a demographic questionnaire and four depression screening tools: Patient Health Questionnaire (PHQ)-9, PHQ-2, Hospital Anxiety and Depression Scale (HADS-D), and Geriatric Depression Scale (GDS-15). Participants then completed the Structured Clinical Interview for DSM-IV (SCID), the gold-standard for diagnosing major depression. The questionnaires were validated against the SCID and sensitivity and specificity were calculated at various cut-points. Optimal cut-points for each questionnaire were determined using receiver-operating curve analyses.



Among 122 participants, 59.5% were diagnosed with stroke and 40.5% with transient ischemic attack. The point prevalence of SCID-diagnosed current major depression was 9.8%. At the optimal cut-points, the sensitivity and specificity for each screening tool were as follows: PHQ-9 (sensitivity: 81.8%, specificity: 97.1%), PHQ-2 (sensitivity: 75.0%, specificity: 96.3%), HADS-D (sensitivity: 63.6%, specificity: 98.1%), and GDS-15 (sensitivity: 45.5%, specificity: 84.8%). Areas under the receiver operating characteristic curves were as follows: PHQ-9 86.6%, PHQ-2 86.7%, HADS-D 85.9%, and GDS-15 66.3%.



The PHQ-2 and PHQ-9 are both suitable depression screening tools, taking less than 5 minutes to complete. The HADS-D does not appear to have any advantage over the PHQ-based scales, even though it was designed specifically for medically ill populations. The GDS-15 cannot be recommended for general use in a stroke clinic based on this study as it had worse discrimination due to low sensitivity.
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada.
Joey C
JC
Prisnie
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Critical Care Medicine, University of Calgary, Canada.
Kirsten M
KM
Fiest
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada.
Shelagh B
SB
Coutts
Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada.
Scott B
SB
Patten
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada.
Callie Am
CA
Atta
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada.
Laura
L
Blaikie
Department of Psychiatry and Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada.
Andrew Gm
AG
Bulloch
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada.
Andrew
A
Demchuk
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Medicine, Department of Radiology, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada.
Michael D
MD
Hill
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada.
Eric E
EE
Smith
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Canada Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Canada nathalie.jette@albertahealthservices.ca.
Nathalie
N
Jetté
D000328:Adult; D000368:Aged; D002170:Canada; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000523:psychology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D000073222:Patient Health Questionnaire; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires
GDS-15; HADS-D; PHQ-9; accuracy; mental health; validation