scholarly journals The Validity and Reliability of the Patient Health Questionnaire-9 in Screening for Post-Stroke Depression

2020 ◽  
Author(s):  
Piyapat Dajpratham ◽  
Panate Pukrittayakamee ◽  
Wanlop Atsariyasing ◽  
Kamonporn Wannarit ◽  
Jariya Boonhong ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Gold Standard ◽  
Positive Likelihood Ratio ◽  
Validity And Reliability ◽  
Stroke Patients ◽  
Psychiatric Interview ◽  
Post Stroke ◽  
Dsm 5 ◽  
Patient Health ◽  
Post Stroke Depression

Abstract Background: Depression affects about 30% of stroke survivors within five years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. Methods: The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥ 45 years with a stroke duration 2 weeks–2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder. The summed-scored-based diagnosis of depressive disorder with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. Results: In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 23 patients (20%) were diagnosed with depressive disorder. The Thai PHQ-9 had satisfactory internal consistency (Cronbach’s alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78–0.96). Conclusions: The Thai PHQ-9 has acceptable psychometric properties for screening for post-stroke depression, with a recommended cut-off score of ≥ 6 for a Thai population.

scholarly journals The Validity and Reliability of the Patient Health Questionnaire-9 in Screening for Post-stroke Depression

2019 ◽  
Author(s):  
Piyapat Dajpratham ◽  
Panate Pukrittayakamee ◽  
Wanlop Atsariyasing ◽  
Kamonporn Wannarit ◽  
Jariya Boonhong ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Positive Likelihood Ratio ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Validity And Reliability ◽  
Stroke Patients ◽  
Psychiatric Interview ◽  
Post Stroke ◽  
Patient Health ◽  
Post Stroke Depression

Abstract Depression affects about 30% of stroke survivors within five years. Timely diagnosis and management of post-stroke depression (PSD) facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is one of the good screening tools for post-stroke depression. As yet, no validation studies of depression in Thai stroke patients by the Thai PHQ-9. Methods: The objectives of the study were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing with a psychiatric interview as the gold standard. First-ever stroke patients aged ≥ 45 years with a stroke duration 2 weeks–2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder. The summed-scored based diagnosis of depressive disorder with the PHQ-9 was obtained. The validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. Results: 115 stroke patients (mean age, 64 + 10 years) were enrolled. The mean PHQ-9 score was 5.2 + 4.8. Using DSM-5 criteria, 23 patients (20%) were diagnosed with depressive disorder. The Thai PHQ-9 had satisfactory internal consistency (Cronbach’s alpha, 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI, 0.78–0.96). Conclusions: The PHQ-9 (Thai language version) has acceptable psychometric properties for screening for post-stroke depression, with a recommended cut-off score of 6 or greater in a Thai population. Keywords: depression, Patient Health Questionnaire-9, reliability, screening, stroke, Thai, validity

scholarly journals The Validity and Reliability of the Patient Health Questionnaire-9 in Screening for Poststroke Depression

2019 ◽  
Author(s):  
Piyapat Dajpratham ◽  
Panate Pukrittayakamee ◽  
Wanlop Atsariyasing ◽  
Kamonporn Wannarit ◽  
Jariya Boonhong ◽  
...  
Keyword(s):  
Major Depression ◽  
Predictive Value ◽  
Gold Standard ◽  
Positive Likelihood Ratio ◽  
Health Questionnaire ◽  
Validity And Reliability ◽  
Poststroke Depression ◽  
Stroke Patients ◽  
Psychiatric Interview ◽  
Patient Health

Abstract Background: Poststroke depression affects about 30% of stroke survivors within five years. Timely diagnosis and management facilitate motor recovery and improve independence. The Patient Health Questionnaire-9 (PHQ-9) is one of the good screening tools for poststroke depression. High validity and reliability of the PHQ-9 is clinically essential. Methods: The objectives of the study were to determine the criterion validity and reliability of the PHQ-9 (Thai version) in screening for poststroke depression by comparing with a psychiatric interview as the gold standard. First-ever stroke patients aged ≥ 45 years with a stroke duration 2 weeks–2 years were administered the PHQ-9. The gold standard was a psychiatric interview for major depression. Diagnosis of major depression according to PHQ-9 can be categorical algorithm based and summed score based. The validity of these 2 ways of diagnosis and reliability analyses, and a receiver operating characteristic curve analysis, were performed. Results: Enrolled were 115 stroke patients (mean age, 64 + 10 years). The mean PHQ-9 score was 5.2 + 4.8. Using DSM-5 criteria, 23 patients (20%) were diagnosed with depressive disorder. The PHQ-9 had satisfactory internal consistency (Cronbach’s alpha, 0.78). The categorical algorithm of the PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a continuous measure, an optimal cut-off score of ≥ six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI, 0.78–0.96). Conclusions: The PHQ-9 has acceptable psychometric properties for screening for poststroke depression, with a recommended cut-off score of ≥ six.

Abstract 118: Predictors of Post-Stroke Depression in Ischemic Stroke Patients using the Patient Health Questionnaire-9

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Lauren E Fournier ◽  
Xu Zhang ◽  
Esther Bonojo ◽  
Mary Love ◽  
Jennifer Sanner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Stroke Patients ◽  
Post Stroke ◽  
Patient Health ◽  
Post Stroke Depression

scholarly journals Screening for post-stroke depression in a Brazilian stroke center

2021 ◽  
Author(s):  
Rônney Pinto Lopes ◽  
Lohana Santana Almeida da Silva ◽  
Luiza Ramos de Freitas ◽  
Natalia Trombini Mendes ◽  
Paulo Henrique Maia de Freitas ◽  
...  
Keyword(s):  
Severe Depression ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Prevalence Of Depression ◽  
Psychiatric Complication ◽  
Patient Health ◽  
Post Stroke Depression ◽  
History Of ◽  
Stroke Center

Background: Depression is the most common psychiatric complication in stroke patients. Its impact is relevant and implies greater functional impairment, delays in the rehabilitation process and recurrence of cardiovascular events. Objectives: To investigate the prevalence of depression and its association with other comorbidities in post-stroke patients. Design and setting: A cross-sectional, observational study conducted at a specialized outpatient clinic in Sao Paulo, Brazil. Methods: The Patient Health Questionnaire-9 (PHQ-9), a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily), was applied to 134 stroke survivors between September 2019 and February 2020. Demographic and clinical data were obtained using the same structured questionnaire by neurologists. Results: Moderate to severe depression (PHQ-9 ≥10) was present in 40 (29.9%) patients, of whom 55% were female, 70% were overweight or obese (BMI ≥25) and only 27.5% were over 60 years. 80% of patients had some comorbidity: systemic arterial hypertension in 57.5%, diabetes in 32.5%, cardiac arrhythmias in 22.5% and history of heart attack in 5%. Current and past tobacco smoking was found in 67.5% of patients and half of them were current smokers. Conclusions: The prevalence of depression among stroke patients was high in our study and mostly associated with other comorbidities. Our data show the need to actively search for symptoms related to this condition, aiming for early diagnosis and appropriate treatment.

scholarly journals Psychometric Properties of the Persian Version Post-Stroke Depression Scale: The Case of Neurology Outpatients in Rasht, North Iran

2020 ◽  
Vol 6 (1) ◽  
pp. 57-65
Author(s):  
Somayeh Shokrgozar ◽  
◽  
Maryam Alizade Nia ◽  
Robabeh Soleimani ◽  
Mahnaz Fallahi Kheshtmasjedi ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Roc Curve ◽  
Factor Model ◽  
Depression Scale ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Post Stroke ◽  
Persian Version ◽  
Dsm 5 ◽  
Post Stroke Depression

Background: Psychiatrists use different scales to evaluate post-stroke depression; however, some concerns have raised about their low specificity. Objectives: This study aimed to assess the validity and reliability of the Persian version of the Post-Stroke Depression Scale (PSDS) in Iran. Materials & Methods: In this analytical cross-sectional study, 155 patients with stroke who were referred to neurology clinics in Rasht City, Iran, were interviewed by a psychiatric assistant (Gold Standard DSM-5 interview was used to separate the depressed from the non-depressed). The participants were then assessed by the PSDS and the hospital anxiety and depression scale (HADS). Moreover, a Receiver Operating Characteristic (ROC) curve with the standard Gold DSM-5 interview was used to determine the ability of the scales and to categorize depression. Eventually, the data were analyzed in SPSS v. 19. Results: Data analysis indicates that the factor structure of HADS is one-dimensional, and exploratory and confirmatory analysis supported the fit for the one-factor model as the best fitting model. Bartlett test (The Chi-square=408.217, df=28, P<0.001) showed significant relationships between variables. The internal consistency of HADS was 0.638 for depression and 0.617 for anxiety. The test-retest reliability is equal to for 60 subjects were randomly re-evaluated within one to two weeks, reported that r=0.783, for anxiety and r=0.741 for depression. Finally, based on the ROC curve, the cut-off point of 9 was chosen, and the different severity of depression was distinguished by 9, 14, and 20. Conclusion: The Persian version of PSDS possesses appropriate psychometric properties among the Iranian population.

scholarly journals Toll-like receptor 4-mediated cytokine synthesis and post-stroke depressive symptoms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Michal Korostynski ◽  
Dzesika Hoinkis ◽  
Marcin Piechota ◽  
Slawomir Golda ◽  
Joanna Pera ◽  
...  
Keyword(s):  
Gene Expression ◽  
Depressive Symptoms ◽  
Ex Vivo ◽  
Toll Like Receptor ◽  
Toll Like Receptor 4 ◽  
Post Stroke ◽  
Cytokines And Chemokines ◽  
Patient Health ◽  
Post Stroke Depression ◽  
Cytokine Synthesis

AbstractAltered cytokine synthesis thought to contribute to the pathophysiology of post-stroke depression (PSD). Toll-like receptor 4 (TLR4) is a master regulator of innate immunity. The aim of this study was to explore the putative association between TLR4-mediated cytokine synthesis and subsequent symptoms of PSD. In total, 262 patients with ischemic stroke and without a history of PSD were included. Depressive symptoms were assessed using the Patient Health Questionnaire-9 in 170 patients on Day 8 and in 146 at 3 months after stroke. Blood samples taken on Day 3 after stroke were stimulated ex vivo with lipopolysaccharide (LPS). Ex vivo synthesized cytokines (TNFα, IP-10, IL-1β, IL-6, IL-8, IL-10, and IL-12p70) and circulating cytokines (TNFα, IL-6, sIL-6R, and IL-1ra) were measured using the enzyme-linked immunoassay or cytometric method. RNA sequencing was used to determine the gene expression profile of LPS-induced cytokines and chemokines. LPS-induced cytokine synthesis and the gene expression of TLR4-dependent cytokines and chemokines did not differ between patients with and without greater depressive symptoms. The plasma level of IL-6, but not TNFα, sIL-6R, and IL-1ra, was higher in patients who developed depressive symptoms at 3 months after stroke (median: 4.7 vs 3.4 pg/mL, P = 0.06). Plasma IL-6 predicted the severity of depressive symptoms at 3 months after stroke (β = 0.42, P = 0.03). In conclusion, TLR4-dependent cytokine synthesis was not associated with greater post-stroke depressive symptoms in this study. Circulating IL-6 might be associated with depressive symptoms occurring at 3 months after stroke.

scholarly journals Morphological and Metabolic Alteration of Cerebellum in Patients with Post-Stroke Depression

2016 ◽  
Vol 40 (3-4) ◽  
pp. 420-430 ◽  
Author(s):  
Ling Zhang ◽  
Rubo Sui ◽  
Lei Zhang ◽  
Zhuang Zhang
Keyword(s):  
Magnetic Resonance ◽  
Depression Scale ◽  
Resonance Spectroscopy ◽  
Hamilton Depression Scale ◽  
Stroke Patients ◽  
1H Mrs ◽  
Post Stroke ◽  
Cont Group ◽  
Post Stroke Depression ◽  
Norm Group

Background: To study morphological and metabolic changes of cerebellum with multimodality magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), respective, to explore correlation between cerebellum alteration and severity of depression in patients with post-stroke depression. Methods: 60 subjects, including 40 stroke patients and 20 healthy volunteers were enrolled. Depression of stroke patients was tested by Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD), based on which stroke-patients were grouped into post-stroke depression (PSD group) and without post-stroke depression (CONT group). Results: Volume of cerebellum decreased in PSD group and CONT group compared with healthy volunteer (NORM) group. White matter of cerebellum in PSD group and CONT group was disrupted; such disruption was significantly in PSD group. In addition, there was correlation between cerebellum volume and FA and HDRS scores (P<00.01). The Cho/Cr and Cho/NAA ratios in cerebellum contralateral to stroke lesion in PSD were higher than those in NORM group (P<0.05). Cho/Cr and Cho/NAA ratios in contralateral cerebellum and ratio difference of Cho/Cr in bilateral cerebellum were positively correlated with HAMD scales (P<0.05). Conclusion: Morphologic and metabolic alterations are evident in patients with post-stroke depression, indicating possible involvement of cerebellum in post-stroke-depression occurrence.

Abstract P32: Potential Underuse of Antidepressants in Post Stroke Depression: Data From the AVAIL Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nada El Husseini ◽  
Daniel T Laskowitz ◽  
Amanda C Guidon ◽  
DaiWai M Olson ◽  
Xin Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Status ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Living Situation ◽  
Factors Associated ◽  
Post Stroke ◽  
Depression Status ◽  
Post Stroke Depression ◽  
Antidepressant Use

Background: Post-stroke depression is common, yet little is known about factors associated with antidepressant use in this population Methods: Data from the multicenter, prospective Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) registry was used to identify patients with post-stroke depression and to describe factors associated with antidepressant use. The analysis was performed after 3 months in 1751 ischemic stroke patients who had been admitted to 97 hospitals nationwide; 12 month follow-up was available for 1637 patients. The Get with the Guidelines-Stroke database was used to collect baseline data. Patients were classified as depressed based on a self-report scale (the Patient Health Questionnaire-8; score range 0 to 24, score ≥10 indicating depression). Frequencies were compared with Pearson X 2 and unadjusted ORs were calculated. Results: The prevalence of post stroke depression was similar at 3 and 12 months (19% [331/1751] vs 17% [280/1637], respectively, p=0.17). Regardless of depression status, antidepressant use was higher at 12 months (16% [287/1751] vs 20% [334/1637], p=0.002). Antidepressant use was also higher at 12 months in depressed patients (25% [84/331] vs 35% [98/280], p=0.009). The odds of antidepressant use at 3 months was higher in women than men (OR 1.6, 95% CI 1.2-2.1), Whites vs. Blacks (OR 1.7, 95% CI 1.1-2.8), in patients with vs. without cognitive deficits (OR 1.6, 95% CI 1.2-2.1) and in those with more severe disabilities (mRS≥3 vs. mRS<3, OR 1.7, 95% CI 1.3-2.3). Use did not vary with educational level, marital status, living situation, medication insurance coverage, or stroke recurrence. Similar trends were present at 12 months, except with higher use in those with recurrent stroke or TIA (OR 2.1, 95% CI 1.4-3.1). Conclusion: Three-quarters of depressed stroke patients at 3-months and nearly two-thirds at 12 months were not receiving antidepressants. Regardless of depression status, utilization of antidepressants after 3 and 12 months varied based on gender, race/ethnicity, cognitive status, disability level, and after 12-months, stroke recurrence. The reasons for the apparent underuse of antidepressants in patients with prevalent post-stroke depression require further study.

scholarly journals LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

2012 ◽  
Vol 1 (1) ◽  
pp. 2
Author(s):  
Samina Masood Haider
Keyword(s):  
Emotional Difficulties ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
The Many ◽  
Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

Benefits of antidepressant treatment after a stroke

2017 ◽  
Vol 41 (S1) ◽  
pp. S315-S315 ◽  
Author(s):  
O. Zerriaa ◽  
O. Moula ◽  
S. Ben Saadi ◽  
I. Jelalia ◽  
R. Ghachem
Keyword(s):  
Functional Recovery ◽  
Cognitive Skills ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Antidepressant Therapy ◽  
Motor Deficit ◽  
Stroke Patients ◽  
Double Blind ◽  
Post Stroke ◽  
Post Stroke Depression

IntroductionStroke is an important cause of morbidity and is responsible for 9% of all deaths worldwide. The most frequent neuropsychiatric consequence of stroke is post-stroke depression (PSD). It has been shown to be associated with both impaired recovery and increased mortality. The aim of our study is to determine the benefits of antidepressant prescription after a stroke.MethodThe databases from Medline and PubMed were reviewed for articles related to post-stroke depression (PSD), antidepressant treatment and stroke, post-stroke depression and functional recovery, stroke related impairment.ResultsAntidepressant drugs have been shown to be effective in treating PSD in six double blind randomized studies. Patients treated with antidepressants had better recovery from disability than patients who did not receive antidepressant therapy: it was proved that antidepressant drugs cause an improvement in cognitive skills and functional recovery in PSD patients. In patients with ischemic stroke and moderate to severe motor deficit, the early prescription of fluoxetine with physiotherapy enhanced motor recovery after 3 months. Some studies showed that PSD can be effectively prevented: nortriptyline, fluoxetine, milnacipran and sertraline appeared to be efficacious in preventing depression after stroke and are to use without significant adverse effects in stroke patients.ConclusionAntidepressant treatment plays an increasing role in the management of patients with acute stroke. Therefore, early initiation of antidepressant therapy, in non-depressed stroke patients, may reduce the odds for development of PSD, and improve cognitive and functional recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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