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

Elizabeth Y. Wang

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

Craig Meyer

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

Glenn D. Graham

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

Mary A. Whooley

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

Elizabeth Y. Wang

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

Craig Meyer

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

Glenn D. Graham

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

Mary A. Whooley

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

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, PhD^{1, 2}, Glenn D. Graham, MD, PhD², Mary A. Whooley, MD^{1, 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.