Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke
Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke
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DOI：
10.1159/000360755
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发表时间：
2014-01-01
影响因子：
2.9
通讯作者：
Broomfield, Niall M.
中科院分区：
文献类型：
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作者：
Lees, Rosalind;Stott, David J.;Broomfield, Niall M.
背景：抑郁/焦虑障碍在中风后很常见，对预后有负面影响。指南建议对所有中风幸存者进行筛查，以发现这些问题。然而，对于评估的时间或方法，还没有达成共识。我们调查了非常早期筛查策略的可行性和准确性，以及这对1个月后抑郁症/焦虑症的诊断准确性。方法：以医院焦虑抑郁量表(HADS)和抑郁强度量表(DISCS)为筛查工具，采用蒙特利尔认知评定量表(MoCA)评定认知功能。对连续入院的中风患者进行筛查。在1个月时，我们使用迷你国际神经精神病学访谈(MINI)和重新测试的筛查工具评估临床抑郁/焦虑障碍。我们描述了急性抑郁/焦虑筛查在1个月时用于临床诊断抑郁症/焦虑症的测试准确性，并描述了筛查测试分数的时间变化。我们通过描述能够、同意并完成筛选测试的比例来评估可行性。结果：在4个月的时间里，经过初步医学评估，102/146入院患者适合进行筛查，69人(68%)同意筛查，其中33人(48%)需要研究人员协助才能完成筛查测试。评估的中位时间为2天(智商：1-4)。早期HADS提示抑郁症9例(13%)，腰椎间盘突出症25例(37%)。急性MOCA中位数为21/30。1个月时，61例(88%)提供数据。HADS(焦虑)平均差值：2.5(95%CI：1.2-3.7)，HADS(抑郁)平均差值：1.6(95%CI：0.3-2.9)。迷你定义抑郁症12例(20%)，焦虑症6例(10%)。基线筛查与1个月临床诊断比较，HADS敏感性为0.25(95%CI：0.09-0.53)，特异性为0.94(95%CI：0.84-0.98)；DISS敏感性为0.92(95%CI：0.65-0.99)，特异性为0.78(95%CI：0.64-0.87)。结论：即使在医学上稳定的中风患者中，在急性期进行抑郁/焦虑筛查也可能是不可行或不准确的。一半的参与者需要研究人员的帮助来完成评估。HADS在1个月时对抑郁/焦虑障碍的预测准确性较差，部分原因可能是我们样本中认知障碍的高患病率。在中风后的头几天进行筛查似乎对检测临床上重要的和持续的抑郁/焦虑问题没有用。(C)2014年S.Karger AG，巴塞尔
Background: Depression/anxiety disorders are common after stroke and have a negative impact on outcomes. Guidelines recommend that all stroke survivors are screened for these problems. However, there is no consensus on timing or method of assessment. We investigated the feasibility and accuracy of a very early screening strategy and the diagnostic accuracy this has for depression/anxiety disorders at 1 month. Methods: Screening tools were Hospital Anxiety and Depression Scale (HADS) and Depression Intensity Scale Circles (DISCs); we also assessed cognition using the Montreal Cognitive Assessment (MoCA). Screening was offered to sequential stroke admissions. At 1 month we assessed for clinical depression/anxiety disorder using Mini-International Neuropsychiatric Interview (MINI) and retested screening tools. We described test accuracy of acute depression/anxiety screening for clinical diagnosis of depression/anxiety disorder at 1 month and described temporal change in screening test scores. We assessed feasibility by describing proportions that were able, agreed to and completed the screening tests. Results: Over 4 months, 102/146 admissions were suitable for screening following initial medical assessment, 69 (68%) agreed to screening, of whom 33 (48%) required researcher assistance to complete the screening test battery. Median time to assessment was 2 days (IQR: 1-4). Early HADS suggested n = 9 (13%) with depression; DISCs n = 25 (37%). Median acute MoCA was 21/30. At 1 month, n = 61 (88%) provided data. Repeat scores showed improvement over time; HADS (anxiety) mean difference: 2.5 (95% CI: 1.2-3.7), HADS (depression) mean difference: 1.6 (95% CI: 0.3-2.9). MINI defined n = 12 (20%) with depression and n = 6 (10%) with anxiety disorder. Comparing baseline screening to 1-month clinical diagnosis, HADS sensitivity was 0.25 (95% CI: 0.09-0.53) and specificity 0.94 (95% CI: 0.84-0.98); DISCs sensitivity was 0.92 (95% CI: 0.65-0.99) and specificity 0.78 (95% CI: 0.64-0.87). Conclusions: Even amongst 'medically stable' stroke patients, depression/anxiety screening at the acute stage may not be feasible or accurate. Half of participants required assistance from the researcher to complete assessments. The poor predictive accuracy of HADS for depression/anxiety disorder at 1 month may be due in part to the high prevalence of cognitive impairment in our sample. Screening in the first few days after stroke does not appear useful for detecting clinically important and sustained depression/anxiety problems. (C) 2014 S. Karger AG, Basel