Issues in the Diagnosis of Post-Stroke Depression

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Depression is a common sequela of stroke that is reported to be more frequent in those with left (LBD) than right (RBD) brain damage (Robinson, Kubos, Starr, Rao, & Price, 1983; Robinson, Starr, & Price, 1984). In this paper data will be presented that support the high prevalence of post-stroke depression, but fail to validate a relationship between post-stroke depression and laterality of brain damage. To examine the prevalence of post-stroke depression, a total of 116 stroke patients (N=80 RBD; N=36 LBD) were given a structured clinical interview specifically designed to take into account cognitive impairments when assessing depression in stroke patients. The interview incorporated two commonly used self-report measures of mood and one examiner-rating scale of negative affect. The data collected from this interview were used to determine a DSM-III diagnosis of depression. Findings indicate that (1) 68% of RBD and 56% of LBD patients met DSM-III criteria for depression, (2) the prevalence of both major (33% RBD; 31% LBD) and mild (35% RBD; 25% LBD) depression was the same and independent of the side of the brain that was damaged, (3) the patients' reports of somatic complaints are unreliable predictors of depression, and (4) DSM-III diagnosis of depression is consistent with psychometric measures of depression about 50% of the time. These findings highlight the need to create a comprehensive assessment tool for diagnosing depression in stroke patients.

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