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.

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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).

New study on patterns of depression over time in stroke survivors

Approximately one-third of stroke survivors experience depression at any one time point up to 15 years after their stroke. A recently published study used data from the South London Stroke Register to explore the patterns of development in depression symptoms and to estimate how many people have different severities of depression over time. The study also looked at how patterns of depression symptoms varied with stroke severity, disability, and antidepressant use.

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