Deans' stroke musings: Evaluating Screening Tests for Depression in Post-Stroke Older Adults

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 4, 2018

Evaluating Screening Tests for Depression in Post-Stroke Older Adults

Screening for depression wouldn't be necessary if you gave patients a roadmap to 100% recovery. They would be spending so much time on therapy they wouldn't have time to think of anything else. Solve the primary problem and these secondary ones go away.
http://journals.sagepub.com/doi/abs/10.1177/0891988718778791

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Elizabeth Y. Wang, BA¹

, Craig Meyer, MPH, MS, PhD¹²

1Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA2San Francisco VA Health Care System, San Francisco, CA, USA
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, Glenn D. Graham, MD, PhD²

2San Francisco VA Health Care System, San Francisco, CA, USA
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, , ,

Mary A. Whooley, MD¹²

1Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA2San Francisco VA Health Care System, San Francisco, CA, USA
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, Elizabeth Y. Wang, BA¹

1Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
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, Craig Meyer, MPH, MS, PhD¹²

1Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA2San Francisco VA Health Care System, San Francisco, CA, USA
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, Glenn D. Graham, MD, PhD²

2San Francisco VA Health Care System, San Francisco, CA, USA
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, Mary A. Whooley, MD¹²

1Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA2San Francisco VA Health Care System, San Francisco, CA, USA
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...

First Published May 24, 2018 Research Article

https://doi.org/10.1177/0891988718778791

Article Information

Volume: 31 issue: 3, page(s): 129-135

Article first published online: May 24, 2018; Issue published: May 1, 2018

https://doi.org/10.1177/0891988718778791

Elizabeth Y. Wang, BA¹, Craig Meyer, MPH, MS, PhD¹^,², Glenn D. Graham, MD, PhD², Mary A. Whooley, MD¹^,²

¹Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA

²San Francisco VA Health Care System, San Francisco, CA, USA

Corresponding Author: Elizabeth Y. Wang, Department of Medicine, School of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA. Email: elizabeth.wang@ucsf.edu

Abstract

Abstract

Background:

Uncertainty surrounds which screening test to use in older patients with poststroke depression, in whom symptoms of depression are more complex and often occur in conjunction with other comorbidities. We evaluated screening tests for depression among a cohort of older ambulatory individuals with comorbid ischemic heart disease and prior stroke.

Methods:

We administered 4 depression screening instruments to 148 participants with ischemic heart disease and self-reported stroke from The Heart and Soul Study. Instruments included the 10-item Center for Epidemiologic Studies Depression Scale (CES-D), 9-item and 2-item versions of the Patient Health Questionnaire (PHQ-9 and PHQ-2), and the Whooley questions, a 2-item yes/no questionnaire. We administered the computerized version of the National Institute of Mental Health Diagnostic Interview Schedule as a gold standard.

Results:

Of the 148 participants, 35 (24%) had major depression. The Whooley questions demonstrated the highest sensitivity for detection (89%), followed by the CES-D (80%), PHQ-2 with cut point ≥2 (79%), PHQ-9 (51%), and PHQ-2 with cut point ≥3 (32%). The Whooley questions had a specificity of 0.66, a positive likelihood ratio of 2.61, and a negative likelihood ratio of 0.82. We observed no significant difference in the area under the receiver operating characteristic curve across the 4 instruments.

Conclusion:

In a cohort of ambulatory older adults with coronary heart disease and prior stroke, depression occurred in a fourth of the participants. The simple Whooley questions screening instrument can efficiently detect depression with a high sensitivity in this population, one representative of older patients commonly encountered within a primary care setting.