Background: Poststroke depression (PSD) is a common and invalidating condition, requiring a prompt diagnosis to provide appropriate treatment. The diagnosis of PSD is based on clinical evaluation, supported by psychiatric scales, predominantly constructed to assess ‘functional’ depressive disorders, which can miss important clinical information about PSD. This study evaluated the diagnostic accuracy of the Poststroke Depression Rating Scale (PSDRS), a diagnostic tool specifically devised to assess depression after stroke, in comparison to the Hamilton Depression Rating Scale (Ham-D). Methods: 143 patients were enrolled at their first-ever stroke; 46 subjects received a diagnosis of major depression-like disorder (MDL) and 53 a diagnosis of mood disorder with depressive manifestations (MDDM). Each patient underwent the PSDRS, Ham-D and Mini Mental State Examination. Areas under receiver-operating characteristic curves were calculated to evaluate diagnostic accuracy. Results: At their optimum cut-off points, the Ham-D and PSDRS showed good sensitivity and specificity for MDL or MDL + MDDM; the PSDRS had a higher positive predictive value for MDL in respect of the Ham-D (78 vs. 59%). Furthermore, the diagnostic accuracy of the PSDRS was higher in respect of the Ham-D in aphasic patients. Regression analyses showed that a longer latency from stroke onset predicted misdiagnosis on both PSDRS and Ham-D; the Ham-D was significantly influenced by cognitive impairment while the PSDRS was affected by age. Conclusions: The Ham-D and PSDRS are both reliable diagnostic tools for the diagnosis of PSD. The PSDRS showed a slightly superior positive predictive value for MDL, particularly in aphasic patients, and was not influenced by cognitive dysfunction, a common consequence of stroke affecting the diagnostic performance of the Ham-D. We suggest that the PSDRS could be a useful tool in clinical practice and in therapeutic trials.

Keywords:
Mood disorders, Poststroke Depression Rating Scale, Hamilton Depression Rating Scale
1.
Burvill PW, Johnson GA, Jamrozik KD, Anderson CS, Stewart-Wynne EG, Chakera TM: Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry 1995;166:320–327.
2.
Gainotti G, Azzoni A, Razzano C, Lanzillotta M, Marra C, Gasparini F: The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients. J Clin Exp Neuropsychol 1997;19:340–356.
3.
Hackett ML, Yapa C, Parag V, Anderson CS: Frequency of depression after stroke: a systematic review of observational studies. Stroke 2005;36:1330–1340.
4.
Paolucci S, Gandolfo C, Provinciali L, Torta R, Sommacal S, Toso V, DESTRO Study Group: Quantification of the risk of post stroke depression: the Italian multicenter observational study DESTRO. Acta Psychiatr Scand 2005;112:272–278.
5.
Gainotti G, Antonucci G, Marra C, Paolucci S: Relation between depression after stroke, antidepressant therapy, and functional recovery. J Neurol Neurosurg Psychiatry 2001;71:258–261.
6.
Pohjasvaara T, Vataja R, Leppavuori A, Kaste M, Erkinjuntti T: Depression is an independent predictor of poor long-term functional outcome post-stroke. Eur J Neurol 2001;8:315–319.
7.
Sturm JW, Donnan GA, Dewey HM, Macdonell RA, Gilligan AK, Thrift AG: Determinants of handicap after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004;35:715–720.
8.
Kauhanen M, Korpelainen JT, Hiltunen P, Brusin E, Mononen H, Maatta R, Nieminen P, Sotaniemi KA, Myllyla VV: Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875–1880.
9.
House A, Knapp P, Bamford J, Vail A: Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 2001;32:696–701.
10.
Williams LS, Ghose SS, Swindle RW: Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry 2004;161:1090–1095.
11.
Chen Y, Guo JJ, Zhan S, Patel NC: Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Ann Pharmacother 2006:40:2115–2122.
12.
Gabaldon L, Fuentes B, Frank-Garcia A, Diez-Tejedor E: Poststroke depression: importance of its detection and treatment. Cerebrovasc Dis 2007;24(suppl 1):181–188.
13.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
14.
Beck AT, Ward C, Mendelson M: Beck Depression Inventory (BDI). Arch Gen Psychiatry 1961;4:561–571.
15.
Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382–389.
16.
Aben I, Verhey F, Lousberg R, Lodder J, Honig A: Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients. Psychosomatics 2002;43:386–393.
17.
Demyttenaere K, De Fruyt J: Getting what you ask for: on the selectivity of depression rating scales. Psychother Psychosom 2003:72:61–70.
18.
Tang WK, Ungvari GS, Chiu HF, Sze KH, Yu AC, Leung TL: Screening post-stroke depression in Chinese older adults using the hospital anxiety and depression scale. Aging Ment Health 2004;8:397–399.
19.
Bennett HE, Thomas SA, Austen R, Morris AM, Lincoln NB: Validation of screening measures for assessing mood in stroke patients. Br J Clin Psychol 2006;45:367–376.
20.
Gainotti G, Azzoni A, Marra C: Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression. Br J Psychiatry 1999;175:163–167.
21.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR. Washington, American Psychiatric Association, 2000.
22.
Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
23.
Amstrom M, Adolfsson R, Asplund K: Major depression in stroke patients: a 3 year longitudinal study. Stroke 1993;24:976–982.
24.
Herrmann M, Wallesch CW: Depressive changes in stroke patients. Disability Rehabil 1993;15:55–66.
25.
Berg A, Palomaki H, Lehtihalmes M, Lonnqvist J, Kaste M: Poststroke depression in acute phase after stroke. Cerebrovasc Dis 2001;12:14–20.
26.
Berg A, Palomaki H, Lehtihalmes M, Phil L, Lonnqvist J, Kaste M: Poststroke depression: an 18 month follow-up. Stroke 2003;34:138–143.
27.
Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL: Performance of screening and diagnostic tests: application of receiver operating characteristic analysis. Arch Gen Psychiatry 1987;44:550–555.
28.
Measso G , Cavarzeran F, Zappalà G, Lebowitz BD, Crook TH, Pirozzolo FJ, Amaducci LA, Massari D, Grigoletto D: The Mini-Mental State Examination: normative study of an Italian random sample. Dev Neuropsychol 1993;9:77–85.
29.
Stern RA, Bachman DL: Depressive symptoms following stroke. Am J Psychiatry 1991;148:351–356.
30.
Benaim C, Cailly B, Perennou D, Pelissier J: Validation of the Aphasic Depression Rating Scale. Stroke 2004;35:1692–1696.
31.
Laska AC, Martensson B, Kahan T, von Arbin M, Murray V: Recognition of depression in aphasic stroke patients. Cerebrovasc Dis 2007;24:74–79.
32.
Gainotti G, Azzoni A, Gasparini F, Razzano C, Marra C, Lanzillotta M: Relation of lesion location to verbal and nonverbal mood measures in stroke patients. Stroke 1997;28:2145–2149.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.