Evaluating Screening Tests for Depression in Post-Stroke Older Adults

• Published in: Journal of geriatric psychiatry and neurology Vol. 31; no. 3; p. 129
• Main Authors: Wang, Elizabeth Y, Meyer, Craig, Graham, Glenn D, Whooley, Mary A
• Format: Journal Article
• Language: English
• Published: United States 01.05.2018
• Subjects: Aged; Cohort Studies; Depression - diagnosis; Depression - psychology; Depressive Disorder, Major - diagnosis; Female; Geriatric Assessment; Humans; Male; Mass Screening - methods; Middle Aged; Predictive Value of Tests; Reproducibility of Results; ROC Curve; Self Report; Sensitivity and Specificity; Stroke - physiopathology; Surveys and Questionnaires; geriatric populations; stroke; depression screening
• ISSN: 0891-9887
• DOI: 10.1177/0891988718778791

Uncertainty surrounds which screening test to use in older patients with poststroke depression, in whom symptoms of depression are more complex and often occur in conjunction with other comorbidities. We evaluated screening tests for depression among a cohort of older ambulatory individuals with comorbid ischemic heart disease and prior stroke. We administered 4 depression screening instruments to 148 participants with ischemic heart disease and self-reported stroke from The Heart and Soul Study. Instruments included the 10-item Center for Epidemiologic Studies Depression Scale (CES-D), 9-item and 2-item versions of the Patient Health Questionnaire (PHQ-9 and PHQ-2), and the Whooley questions, a 2-item yes/no questionnaire. We administered the computerized version of the National Institute of Mental Health Diagnostic Interview Schedule as a gold standard. Of the 148 participants, 35 (24%) had major depression. The Whooley questions demonstrated the highest sensitivity for detection (89%), followed by the CES-D (80%), PHQ-2 with cut point ≥2 (79%), PHQ-9 (51%), and PHQ-2 with cut point ≥3 (32%). The Whooley questions had a specificity of 0.66, a positive likelihood ratio of 2.61, and a negative likelihood ratio of 0.82. We observed no significant difference in the area under the receiver operating characteristic curve across the 4 instruments. In a cohort of ambulatory older adults with coronary heart disease and prior stroke, depression occurred in a fourth of the participants. The simple Whooley questions screening instrument can efficiently detect depression with a high sensitivity in this population, one representative of older patients commonly encountered within a primary care setting.