Abstract W P316: Improved Detection and Treatment of Post-Stroke Depression Utilizing Patient Health Questionaire-9 (PHQ-9) Screening over Standard Methods
Background and Purpose: Post-stroke depression is common, with an estimated prevalence of 30-35%. This study assessed the null hypothesis that PHQ-9 screening is equivalent to standard care (suicide screening + provider assessment) in detection of post-stroke depression. A secondary outcome was to assess the optimal timing and setting to perform PHQ-9 screening after stroke.
Methods: PHQ-9 screenings and modified Rankin Scales were conducted in a prospective study population (n=49) at three time points - inpatient within 48 hours of admission for stroke, 7 days after discharge at the outpatient stroke clinic, and by telephone at 90 days. Actionable treatment of depression defined as psychiatry referral and/or initiation of antidepressants were recorded. A retrospective control group (n=125), prior to initiation of the PHQ-9, was reviewed to determine baseline rates for treatment of depression.
Results: PHQ-9 screening increased actionable treatment of depression over standard methods from 5.6% to 18.4% (p=0.009, 95% CI 1.6-25% increase) with similar baseline characteristics of age (p=0.406), gender (p=0.9), and antidepressant therapy prior to admission (p=0.377) between groups. 20.4% of the study population had a score of ≥ 10 (depression) at one time point and 59% of the study population had a score of ≥5 signifying minimal symptoms of depression at one time point. 51% experienced an increase in their PHQ-9 from inpatient screening to the outpatient stroke clinic. A significant number, 28.6%, were lost to follow-up at 90 days. In multivariate analysis, predictors of high PHQ-9 scores in stroke patients were young age (p=0.015) and trend with prior antidepressant use (p=0.06). Gender was insignificant (p=0.266).
Conclusions: PHQ-9 screening significantly increased our detection and treatment of post-stroke depression and sub-optimally treated pre-morbid depression. The outpatient stroke clinic seems to be the optimal time point for screening due to increased scores and the difficulty in obtaining scores at 90 days. Young age and prior antidepressant use predispose high PHQ-9 scores post-stroke.
Author Disclosures: A. Hooker: None. E. Tatum: None. C. Roels: None.
- © 2014 by American Heart Association, Inc.