Senior Research Fellow, Heart Research Centre, Box 2137 Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.
Stroke. 2012 Apr;43(4):1000-5. doi: 10.1161/STROKEAHA.111.643296. Epub 2012 Feb 23.
Screening tools for depression and psychological distress commonly used in medical settings have not been well validated in stroke populations. We aimed to determine the accuracy of common screening tools for depression or distress in detecting caseness for a major depressive episode compared with a clinician-administered structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders Fourth Edition as the gold standard.
Seventy-two participants ≥3 weeks poststroke underwent a diagnostic interview for major depressive episode and completed the Patient Health Questionnaire-2 and -9, Hospital Anxiety and Depression Scale, Beck Depression Inventory-II, Distress Thermometer, and Kessler-10. Internal consistency, sensitivity, specificity, likelihood ratios, and posttest probabilities were calculated. Each measure was validated against the gold standard using receiver operating characteristic curves with comparison of the area under the curve for all measures.
Internal consistency ranged from acceptable to excellent for all measures (Cronbach α=0.78-0.94). Areas under the curve (95% CI) for the Patient Health Questionnaire-2, Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale depression and total score, Beck Depression Inventory-II, and Kessler-10 ranged from 0.80 (0.69-0.89) for the Kessler-10 to 0.89 (0.79-0.95) for the Beck Depression Inventory-II with no significant differences between measures. The Distress Thermometer had an area under the curve (95% CI) of 0.73 (0.61-0.83), significantly smaller than the Beck Depression Inventory-II (P<0.05).
Apart from the Distress Thermometer, selected scales performed adequately in a stroke population with no significant difference between measures. The Patient Health Questionnaire-2 would be the most useful single screen given free availability and the shortest number of items.
在医疗环境中常用的抑郁和心理困扰筛查工具在中风人群中尚未得到很好的验证。我们旨在确定常用的抑郁或困扰筛查工具在检测与《精神障碍诊断与统计手册第四版》临床医生管理的结构化临床访谈为金标准的重度抑郁症发作病例中的准确性。
72 名≥3 周的中风后患者接受了重度抑郁症发作的诊断访谈，并完成了患者健康问卷-2 和-9、医院焦虑和抑郁量表、贝克抑郁量表-II、痛苦温度计和 Kessler-10。计算了内部一致性、敏感性、特异性、似然比和后测概率。使用接受者操作特征曲线对所有措施进行了比较，并比较了所有措施的曲线下面积，将每个措施与金标准进行了验证。
所有措施的内部一致性均在可接受到优秀之间（Cronbach α=0.78-0.94）。患者健康问卷-2、患者健康问卷-9、医院焦虑和抑郁量表抑郁和总分、贝克抑郁量表-II 和 Kessler-10 的曲线下面积（95%CI）范围从 Kessler-10 的 0.80（0.69-0.89）到贝克抑郁量表-II 的 0.89（0.79-0.95），各措施之间无显着差异。痛苦温度计的曲线下面积（95%CI）为 0.73（0.61-0.83），明显小于贝克抑郁量表-II（P<0.05）。
除了痛苦温度计外，所选量表在中风人群中表现良好，各措施之间无显着差异。鉴于患者健康问卷-2 是免费提供且项目数最短的，它将是最有用的单一筛查工具。
