Stroke survivors present unique challenges to identifying depression. Stroke-related neurological deficits including flat or monotone speech, flat affect, aphasia and subtle clues such as refusal to participate in therapies and emotional lability may hinder healthcare practitioners’ identification of PSD and lead to under diagnosis and treatment of PSD.
PSD has been shown to increase hospital charges, increase hospital length of stay for acute stroke care, decrease cognitive and functional outcomes, decrease quality of life, increased risk for recurrent stroke at 1 year and increased stroke mortality.
Controversy remains regarding whether or not routine screening for PSD improves outcomes
Additionally, there is uncertainty regarding the optimal screening tool for PSD. Several depression screening tools are utilized to screen for PSD with varying success including the 21-item Hamilton Depression Rating Scale (HDRS) (sensitivity: 0.84; 95% CI, 0.75–0.90; specificity: 0.83; 95% CI, 0.72–0.90), the 20-item Center of Epidemiological Studies-Depression Scale (CES-D) (sensitivity: 0.75; 95% CI, 0.60–0.85; specificity: 0.88; 95% CI, 0.71–0.95) and the 9-item Patient Health Questionnaire (PHQ-9) (sensitivity: 0.86; 95% CI, 0.70–0.94; specificity: 0.79; 95% CI, 0.60–0.90) which is widely used however, may be better suited as screening tool to identify stroke survivors without depression rather than stroke survivors with depression.
Research has shown that screening for PSD in conjunction with collaborative care intervention including an interdisciplinary approach to patient care consisting of a structured plan of care, evidence-based treatment interventions, scheduled patient follow-ups and enhanced interdisciplinary communication results in better outcomes for this population.
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