Depression and anxiety screening after stroke: adherence to guidelines and future directions

Abstract

Purpose: This article examines practical approaches to increasing rates of screening for depression and anxiety in hospital-based stroke services. Method: The literature on depression and anxiety following stroke is briefly reviewed together with evidence relating to screening. A small-scale trial of an educational and support package to improve screening rates compared 30 consecutive admissions before and after the intervention. An extended commentary on the outcome considered alternative approaches to improving screening. Results: The literature review confirmed that depression after stroke has multiple adverse effects and that screening is not universally applied. There has been less research into anxiety after stroke, but it is likely that anxiety screening is also incomplete. The trial of the intervention to promote screening demonstrated strong trends towards improvement for depression (23.3%; odds ratio 2.67; χ² p = 0.067) and a trend for anxiety (16.7%; odds ratio 1.96; χ² p = 0.20). Conclusions: Education and training about depression and anxiety screening and access to screening materials improved rates of screening to a limited degree. An extended commentary explored how screening rates might be further improved by considering the intervention strategy, the staffing model, the training approach and the screening methods themselves. Finally, consideration is given to treatment approaches for mood disorders.

Implications for Rehabilitation

• Screening is necessary to identify stroke patients who require treatment for psychological disorders. However, anxiety and depression are not explicitly screened for, or considered, in up to half of all stroke patients.

• Simple interventions providing education and support for training may improve rates of screening.

• Major improvements in screening rates will require the development of systematic protocols, using the principles of knowledge translation, that consider organizational factors, the staff involved, the training required and the screening instruments to use.

Keywords::

• Depression
• mood
• screening
• stroke

Declaration of interest: The authors report no conflicts of interest.