Table 4

Evidence summary on meta-analysis of depression scales for acute and non-acute stroke

Instrument	Total sample size (number of studies)	Sensitivity (95% CI)	Specificity (95% CI)	Positive predictive value (95% CI)*	Negative predictive value (95% CI)*	Rule-in clinical utility**	Rule-out clinical utility**
Acute stroke*
GDS-15	440 (3)	0.81 (0.65 to 0.91)	0.77 (0.62 to 0.82)	0.63 (0.45 to 0.83)	0.89 (0.77 to 0.94)	Fair	Good
MADRS	615 (4)	0.85 (0.78 to 0.90)	0.79 (0.70 to 0.86)	0.67 (0.56 to 0.76)	0.91 (0.87 to 0.95)	Fair	Good
HADS-T	411 (3)	0.67 (0.29 to 0.91)	0.88 (0.62 to 0.97)	0.73 (0.36 to 0.94)	0.84 (0.64 to 0.96)	Poor	Good
HDRS†	769 (4)	0.86 (0.75 to 0.93)	0.86 (0.75 to 0.93)	0.75 (0.60 to 0.87)	0.93 (0.86 to 0.96)	Good	Good
HADS-D	1024 (6)	0.85 (0.76 to 0.91)	0.69 (0.57 to 0.78)	0.57 (0.47 to 0.67)	0.90 (0.83 to 0.95)	Poor	Fair
BDI	725 (3)	0.83 (0.78 to 0.88)	0.76 (0.58 to 0.88)	0.63 (0.48 to 0.78)	0.90 (0.84 to 0.94)	Fair	Good
Post-acute*
HDRS*	673 (4)	0.82 (0.69 to 0.90)	0.75 (0.62 to 0.84)	0.62 (0.50 to 0.73)	0.89 (0.80 to 0.94)	Fair	Good
CES-D	134 (3)	0.64 (0.48 to 0.78)	0.85 (0.52 to 0.97)	0.68 (0.33 to 0.93)	0.83 (0.67 to 0.90)	Poor	Good
HADS-D	544 (3)	0.87 (0.46 to 0.98)	0.73 (0.65 to 0.79)	0.61 (0.39 to 0.70)	0.92 (0.71 to 0.99)	Poor	Good
BDI	638 (3)	0.90 (0.62 to 0.98)	0.55 (0.19 to 0.86)	0.50 (0.27 to 0.78)	0.92 (0.50 to 0.99)	Poor	Poor

*PPVs and NPVs assumes depression prevalence of 33% based on an estimate from a systematic review on prevalence of any depression in stroke patients.7
**See www.clinicalutility.co.uk for more information.
†All scales are self report except the HDRS and the MADRS which are clinician administered scales.
BDI, Beck Depression Inventory; CES-D, Center of Epidemiological Studies-Depression Scale; GDS, Geriatric Depression Scale; HADS, Hospital Anxiety and Depression Scale; HDRS, Hamilton Depression Rating Scale; MADRS, Montgomery Asberg Depression Rating Scale.