Feasibility and Diagnostic Accuracy of Early Mood Screening to Diagnose Persisting Clinical Depression/Anxiety Disorder after Stroke
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».