Potential screening measures for depression and anxiety after stroke

Depression and anxiety are common problems after stroke. The National Clinical Guidelines for stroke (Royal College Physicians, 2004) recommend that all patients are screened for low mood. The aim of the review was to identify measures which could be used for this purpose and to review the evidence for their sensitivity and specificity with stroke patients. A literature search was conducted using electronic databases, including Medline, Embase, PsycInfo and CINAHL, to identify articles published in peer reviewed journals on mood assessment after stroke. Questionnaire measures were identified which were appropriate only for those able to communicate verbally. In addition visual analogue and observer rating scales were identified which were considered appropriate for all stroke patients. The hospital anxiety and depression scale (HADS) and general health questionnaire (GHQ) had most evidence to support their use as screening measures for people without communication problems. The stroke aphasic depression questionnaire–hospital version (SADQ-H) had best support for use as a screening measure for those with communication problems. No measures were identified that had been validated as screening measures for anxiety after stroke. The HADS, GHQ12 and SADQ-H10 were recommended as short screening measures suitable for detecting depression after stroke. However the cut-offs giving good sensitivity and specificity were not well established for stroke patients and measures need to be developed for detecting anxiety.