Introduction: Depression screening may not be feasible for all stroke patients during their hospitalization, and depression may be missed if screening is not performed in the outpatient setting.
Hypothesis: We sought to assess the proportion of patients with depression, and describe the severity of depressive symptoms in patients who could not be screened during hospitalization. We hypothesized that depressive symptoms can be missed in those who are not screened.
Methods: Ischemic strokes (July 2014- July 2015) were identified from the clinic registry. In the clinic, we use Patient Health Questionnaire 9 (PHQ-9) to assess depressive symptoms for all patients. Univariate and multivariable linear regression analyses were used to evaluate associations between PHQ-9 and age, sex, race, baseline National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and antidepressant use for patients who missed inpatient depression screening.
Results: Among 159 ischemic stroke patients, 136 completed outpatient PHQ-9 within 90 days from stroke onset. Of these 41 (30%) were missing inpatient PHQ-9. Reasons for missing scores included aphasia or cognitive impairment (20), failed inpatient attempt (16), or unspecified reasons (5). Among the 41 patients, median time to follow-up was 40 days (IQR 33 - 50). Mean (SD) age was 63.7 (13.8) and 51.2% were female. Mean (SD) PHQ-9 score was 8.0 (6.61). The overall proportion of patients having at least mild depression was 60.1% (95 % CI 45.3, 76.5) and PHQ-9 scores were distributed as follows: none to minimal depressive symptoms, 39.0%; mild to moderate, 43.9%, moderately severe to severe, 17.1%. In the regression model, mRS at follow-up (dichotomized < 3 & ≥ 3) was associated with severity of depressive symptoms after adjusting for age, sex, and baseline NIHSS, (coefficient 4.1, 95% CI 1.38, 6.82). Other variables were not associated with severity of depressive symptoms.
Conclusions: Patients who cannot be screened for depression during hospitalization may have depressive symptoms and should be screened as soon as feasible after discharge. Alternative methods to screen cognitively impaired patients need to be developed.