Comparing the EQ-5D-3L anxiety or depression domain to the Hospital Anxiety and Depression Scale to identify anxiety or depression after stroke

ABSTRACT

Background

Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke.

Methods

Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke.

Results

Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke.

Conclusions

The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against “gold standard” clinical assessment is required for clinical applications.

KEYWORDS:

• Anxiety
• depression
• sensitivity
• specificity
• mass screening
• registries

Acknowledgments

We acknowledge members of the Australian Stroke Clinical Registry (AuSCR), staff from the Florey Institute of Neuroscience and Mental Health who manage the AuSCR. We also thank the patients who contribute data to AuSCR.

Declarations of interest statement

DAC is the current Data Custodian for Australian Stroke Clinical Registry (AuSCR). NAL and DAC are members of the AuSCR Steering or Management Committees. DAC reports receiving restricted grants from Boehringer Ingelheim, Ipsen, Medtronic, and Shire outside the submitted work. The other authors report no conflicts.

Authors’ contributions

TT led the study design, data collection, analysis, and preparation of the manuscript. NAE and RS contributed to the preparation of this manuscript and data analysis. NAL contributed to comments and manuscript revisions. DAC oversaw data collection, management, contributed to comments and manuscript revisions.

Availability of Data and Material

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

Australian Stroke Clinical Registry (AuSCR) was supported by grants from the National Health and Medical Research Council (NHMRC: 1034415), Monash University, Queensland Health, Victorian Department of Health and Human Services, the Stroke Foundation, Allergan Australia, Ipsen, Boehringer Ingelheim, and consumer donations. TT was supported by the Australian Government Research Training Program Scholarship. The following authors receive Research Fellowship support from the NHMRC: NEA (1072053), and DAC (1063761 co-funded by National Heart Foundation of Australia; 1154273); and NAL (1102055) from the National Heart Foundation of Australia.