From the University of Edinburgh (S.O'R., D.S., M.D.),
Neurosciences Trials Unit, Department of Clinical Neurosciences, The
University of Edinburgh, and the Edinburgh Health Care NHS Trust (S.M.), Royal
Edinburgh Hospital, Edinburgh, Scotland.
Correspondence to Martin Dennis, MD, University of Edinburgh, Neurosciences Trials Unit, Department of Clinical Neurosciences, The University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Rd, Edinburgh, UK EH4 2XU. E-mail MSD{at}skull.dcn.ed.ac.uk
Background and Purpose—Mood
disorders are common after stroke and may impede physical, functional,
and cognitive recovery, making early identification and treatment of
potential importance. We aimed to compare the accuracy of the General
Health Questionnaire (GHQ-30) and the Hospital Anxiety and Depression
(HAD) Scale in detecting psychiatric morbidity after stroke and to
determine the most suitable cutoff points for different
purposes.
Methods—One hundred five hospital-referred stroke patients
completed both the GHQ-30 and HAD Scale 6 months after onset before a
blinded psychiatric assessment in which the Schedule for Affective
Disorders and Schizophrenia with some supplementary questions was used
to determine a DSM-IV (Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition) diagnosis. Measures
were compared in terms of sensitivity, specificity, and receiver
operating characteristic curves.
Results—No significant differences were found between the GHQ-30
and the HAD Scale in identifying those patients with any DSM-IV
diagnosis (P=0.95), grouped depression
(P=0.56), or anxiety (P=0.25) disorders.
The previously recommended cutoff points for identifying "cases"
for the GHQ (4/5) and for the HAD Scale (8/9 and 11/12) were found to
be suboptimal in this population.
Conclusions—The GHQ-30 and HAD scale exhibited similar levels of
sensitivity and specificity. Data are presented, taking into
account the "cost" of false-positives and negatives, to allow a
choice of cutoff points suitable for differing situations.
© 1998 American Heart Association, Inc.
Original Contributions
Detecting Psychiatric Morbidity After Stroke
Comparison of the GHQ and the HAD Scale
Key Words: anxiety • depression • stroke
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