George Institute for International Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia.
Stroke. 2010 Mar;41(3):478-81. doi: 10.1161/STROKEAHA.109.571729. Epub 2010 Jan 21.
There has been an increase in screening for depression in the physically ill. We explored whether important negative cognitions may be missed by conventional approaches to screening for depression in 2 independently conducted stroke studies with similar methods.
The Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based stroke incidence study conducted in Auckland, New Zealand, for 12 months in 2002 to 2003. The Stroke Outcomes Study was a prospective, hospital cohort study conducted in Leeds and Bradford, United Kingdom, for 33 months in 2002 to 2005. Symptoms of abnormal mood were assessed at 6 months in ARCOS with a single simple question, "Do you often feel sad and depressed?" and the 28-item General Health Questionnaire administered as part of a structured interview and in the Stroke Outcomes Study with the 28-item General Health Questionnaire and a single question about depressed mood taken from the Present State Examination.
Mood data were available at 6 months from 770 ARCOS and 492 Stroke Outcomes Study participants. A significant proportion (up to 28%) of people who did not meet study criteria for depression reported important negative cognitions such as hopelessness, worthlessness, or suicidality. People who were older, dependent in activities of daily living, or not partnered were more likely to report negative cognitions.
Important negative cognitions, including suicidal thoughts, may be missed when people are screened for depression after stroke. Screening alone is not an adequate substitute for a sensitive exploration of the psychological impact of stroke on the survivor.
在躯体疾病患者中，抑郁症的筛查有所增加。我们通过两项独立开展的、采用类似方法的脑卒中研究来探讨，在常规抑郁症筛查中是否会遗漏重要的负性认知。
奥克兰区域社区脑卒中（ARCOS）研究是一项前瞻性、基于人群的脑卒中发病率研究，于 2002 年至 2003 年在新西兰奥克兰开展，为期 12 个月。脑卒中结局研究是一项前瞻性、医院队列研究，于 2002 年至 2005 年在英国利兹和布拉德福德开展，为期 33 个月。在 ARCOS 中，于 6 个月时采用一个简单的单项问题“您是否经常感到悲伤和沮丧？”评估异常情绪症状；并通过结构化访谈和 28 项一般健康问卷（GHQ）进行评估。在脑卒中结局研究中，采用 28 项 GHQ 和取自当前状态检查的关于抑郁心境的一个单项问题进行评估。
来自 770 名 ARCOS 和 492 名脑卒中结局研究参与者的 6 个月时的情绪数据可用。比例高达 28%的不符合研究抑郁症标准的人群报告了重要的负性认知，如绝望、无价值或自杀意念。年龄较大、日常生活活动依赖或未婚的人群更可能报告负性认知。
在脑卒中后对患者进行抑郁症筛查时，可能会遗漏重要的负性认知，包括自杀想法。单纯的筛查并不能充分替代对脑卒中幸存者心理影响的敏感探索。
