Screening for depression and anxiety in stroke: how useful is HADS?

This post is based on a peer-reviewed journal article (may require subscription to access) that is available online and is due to be published in the Journal of Affective Disorders in March 2018 as: Evaluation of the Hospital Anxiety and Depression Scale (HADS) in screening stroke patients for symptoms: Item Response Theory (IRT) analysis. Authors: Salma A. Ayis, Luis Ayerbe, Mark Ashworth, Charles DA Wolfe. The authors are from King’s College London, Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, and Queen Mary University. The authors have not reviewed this post.

Many stroke survivors experience depression and anxiety, which impacts on function and recovery (as well as the mental health burden) (e.g. see post Long-term outcomes: survivors’ experiences up to 15 years after stroke). However, estimates for rates of depression and anxiety vary considerably. The variation could be due to several things: for example, the way the patient is assessed, and what the ‘cut-off’ points are for diagnosing someone with anxiety or depression.

The standard tool used in primary and secondary care for determining whether someone has depression and/or anxiety is the Hospital Anxiety and Depression scale (HADS). In an evaluation of HADS (paper referenced at top), researchers used data from the South London Stroke Register (SLSR) to understand what information the HADS items give about anxiety and depression in the SLSR population up to 5 years after stroke.

Statistical methods (factor analysis and Item Response Theory methods) were used with the SLSR data. The findings confirmed that HADS measures depression and anxiety as two distinct domains, but also suggest that some HADS items are more useful than others for clinicians who want to determine whether someone has anxiety and/or depression, or to measure the severity of symptoms. The study also showed that some items seemed to give similar information about symptoms. Potentially, clinicians/researchers could use items selected because of their properties, rather than all the items, enabling more precise patient screening. The researchers suggest that more needs to be known about how stroke survivors perceive the items, to determine which items might not be necessary.

The Burden of Stroke in Europe report: need for more support for more stroke survivors.

BoS coverThe number of strokes across the UK could rise by almost half (44 per cent) (i) in the next 20 years, according to a new report (ii) by researchers from King’s College London. The expected increase is due to our ageing population. The chance of having a stroke increases as we get older.

The increase in strokes means that the number of people living with the effects of stroke in the UK could rise by a third (32 per cent) by 2035 (iii).

The researchers cannot be sure about the predicted size of the increase, partly because the data on how many strokes happen and how many people survive stroke is not perfect.

The quality of hospital care for stroke patients varies widely across Europe. The researchers also found that, in general, countries in Europe do not collect (or publish) much information on what care stroke survivors get after they leave hospital. The data that is available shows that between countries and within countries (including the UK), there is a lot of variation in the care and support offered to stroke survivors. The researchers conclude that there needs to be more of a focus on long-term rehabilitation and support.

The main report and other publications from the project can be accessed online for free by entering your email address at the following link: http://strokeeurope.eu/

The Burden of Stroke in Europe project was commissioned by the Stroke Alliance for Europe (SAFE) and the Stroke Association.

(i) Incidence estimate: 43,326 strokes in the UK in 2015, projected to rise to 62,366 strokes in 2035

(ii) Eleanor Stevens, Eva Emmett, Yanzhong Wang, Christopher McKevitt, Charles DA Wolfe (2017). The Burden of Stroke in Europe. Stroke Alliance for Europe

(iii) The number of stroke survivors in the UK is projected to rise to 193,861 in 2035

Predicting functional recovery after stroke

Clinical prediction of a patient’s recovery is an important medical aim for stroke survivors.

A team including researchers from King’s College London developed and checked (validated) a tool that seems to accurately predict how well or poorly a patient will recover after their stroke. The team used data from the South London Stroke Register  to develop and check the tool. The tool could help clinicians to work out the likely recovery of a patient based on various factors such as their age, sex, level of disability and stroke subtype. They could use this information to provide more personalised care for patients.

The report on this study is published in the International Journal of Stroke as ‘Patient-specific prediction of functional recovery after stroke’. It was written by
Abdel Douiri, Justin Grace, Shah-Jalal Sarker, Kate Tilling, Christopher McKevitt, Charles DA Wolfe, and Anthony G Rudd. It may require a subscription or payment to view:  https://doi.org/10.1177/1747493017706241

Long-term outcomes: survivors’ experiences up to 15 years after stroke

*new* Dr. Siobhan Crichton and Dr. Benjamin Bray  talk about this study on a Soundcloud podcast by BMJ Talk Medicine.

Researchers at King’s College London use South London Stroke Register data to understand the long term consequences of stroke. Recently they did an analysis of outcomes for Register participants who lived up to 15 years after their stroke. The outcomes they looked at were survival, disability, activity, cognitive impairment, quality of life, depression and anxiety.

The researchers found that one in five people live at least 15 years after their stroke, and that many of these people live with disability and psychological problems. For example, one in 10 of the people who lived for 15 years after their stroke had lived with moderate to severe disability since their stroke.

The study emphasises that, as more people survive stroke, “research and health services will need to increasingly focus on preventing and managing the long-term consequences of stroke”.

The study was designed and carried  out by researchers and clinicians at King’s College London and the NIHR Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London. The article described is published as: Crichton, S. L., B. D. Bray, C. McKevitt, A. G. Rudd and C. D. A. Wolfe (2016). “Patient outcomes up to 15 years after stroke: survival, disability, quality of life, cognition and mental health.” Journal of Neurology, Neurosurgery & Psychiatry (may require subscription to access).