J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304194
  • Neuropsychiatry
  • Research paper

Screening for poststroke major depression: a meta-analysis of diagnostic validity studies

  1. Alex J Mitchell2
  1. 1Centre for Reviews and Dissemination, University of York, York, UK
  2. 2Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Dr Nick Meader, Centre of Reviews and Dissemination, University of York, York YO10 5HU, UK; nick.meader{at};
  • Received 21 September 2012
  • Revised 19 December 2012
  • Accepted 9 January 2013
  • Published Online First 5 February 2013


Background Major depression is common in stroke patients and associated with increased rates of disability and mortality. Identifying depression may improve mental and physical health. The aim of this review was to determine the most accurate tool for detecting poststroke depression.

Methods Seven databases were searched up to November 2012. Two authors selected studies using International Classification of Disease  or Diagnostic and Statistical Manual diagnosis of depression as the reference standard. Two authors extracted data and assessed methodological quality. Included studies were synthesised using meta-analyses.

Results A total of 24 included studies provided data on 2907 participants. The Center of Epidemiological Studies-Depression Scale (CESD) (sensitivity: 0.75; 95% CI 0.60 to 0.85; specificity: 0.88; 95% CI 0.71 to 0.95), the Hamilton Depression Rating Scale (HDRS) (sensitivity: 0.84; 95% CI 0.75 to 0.90; specificity:0.83; 95% CI 0.72 to 0.90) and the Patient Health Questionnaire (PHQ)-9 (sensitivity: 0.86; 95% CI 0.70 to 0.94; specificity: 0.79; 95% CI 0.60 to 0.90) appeared to be the optimal measures for screening measures. However, the clinical utility of all tools was modest for case-finding.

Interpretation There are a number of possible instruments that may help in screening for poststroke depression but none are satisfactory for case-finding. Preliminary data suggests the CESD, HDRS or the PHQ-9 as the most promising options. Although it should be noted such scales should not be used in isolation but followed up with a more detailed clinical assessment. While there is promising data for the PHQ-2 in other populations, it performed less well than other measures.

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