Can nurses help identify patients with depression following stroke? A pilot study using two methods of detection

AIM: This paper reports a study to determine the accuracy of the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale, when administered by a nurse, in detecting depression in patients who have recently had a stroke. BACKGROUND: After a stroke, survivors spend considerable amounts of time in the direct care of nurses. Many show signs of depression, and this has been associated with an adverse effect on recovery and rehabilitation. Identifying those with depression when they have communication and cognitive difficulties is especially difficult. Treatments are available to assist in the management of depression, and early detection and intervention may assist in this process. METHOD: A cross-sectional pilot study was conducted, comparing (a) clinical diagnosis of depression by a psychiatrist with (b) two clinical interviews, using the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale, conducted by a nurse. The data were collected in 2002. FINDINGS: Twenty-eight patients, who were still in hospital in the second week poststroke, were included. The median age was 72 (interquartile range: 61-78). There were 14 males. The psychiatrist rated seven (25%) patients as depressed. The Geriatric Mental State examination had a sensitivity of 71%, a specificity of 67%, a positive predictive value of 42%, a negative predictive value of 88% in detecting depression and an overall efficiency of 68%. The Montgomery-Asberg Depression Rating Scale had a sensitivity of 100%, a specificity of 65%, a positive predictive value of 54%, a negative predictive value of 100% and an overall efficiency of 75%. CONCLUSION: In this study, the Geriatric Mental State examination and the Montgomery-Asberg Depression Rating Scale were at least as efficient at detecting the depression in patients who have had a stroke. However, as the Montgomery-Asberg Depression Rating Scale is quicker to administer, it may prove more useful to nurses clinically.