Abstract NS3: The Hospital Anxiety and Depression Scale Has Limitations in Inpatient Post Stroke Depression Screening
Background and Purpose: While the prevalence of post stroke depression (PSD) is high (ranging from 33% to 50%), it is often underdiagnosed and undertreated, impairing recovery for stroke survivors. Comprehensive Stroke Center designation now mandates depression screening. We aimed to evaluate the Hospital Anxiety and Depression Scale (HADS) as a depression screening tool in the inpatient setting for stroke patients.
Methods: A single academic medical center initiated use of the HADS to screen for depression during acute hospitalization in patients with a primary stroke diagnosis. All stroke patients who met the following inclusion criteria between Sept. 2012 and June 2013 were screened: (1) Length of stay (LOS) ≥ to 5 days (2) medically stable (3) cognitively intact (4) no aphasia and (5) English speaking. NCHS data indicate the average inpatient LOS is 5.3 days, as such, we modified the HADS to ask patients to reflect upon their experience over the last five days. Therefore, patients were evaluated on ≥ hospital day 5.
Results: 423 patients were hospitalized with stroke as their primary diagnosis, 44 (10.4%) were eligible to be screened for depression. Short LOS and cognitive/language impairments comprised 75% of the excluded patients. Twenty-six of 44 eligible patients (59%) completed the HADS. Only two patients who were screened had a positive screening result, both of whom were known at admission to have a comorbid diagnosis of depression. No detections of post stroke depression were made.
Conclusions: While identification and treatment of post-stroke depression is critical to support maximal recovery in stroke survivors, the HADS has significant limitations as a screening tool. Many stroke patients had LOS <5 days, which may be too short of a time frame to use the HADS. Alternative instruments for inpatient screening of depression or utilization of other in-hospital prediction models may show promise. Recent research describes a clinical prediction model with accompanying risk-assessment table to identify patients at risk for post stroke depression. Validated screening tools and predictive models for patients with cognitive impairment and communication difficulties should also be explored.
Author Disclosures: S.L. Casal: None. A. Finley-Caulfield: None. W. Tai: None.
- © 2014 by American Heart Association, Inc.