Feasibility of a nurse-led intervention for the early management of depression after stroke in hospital.

AIM: To explore the feasibility of the Post-Stroke Depression toolkit in terms of fidelity and acceptability in daily nursing practice. BACKGROUND: Depression after stroke is common and influences patients' recovery significantly. Although stroke guidelines recommend early depression screening and treatment, depressive symptoms remain unrecognized. To enhance adoption of evidence into the context of the daily practice of stroke treatment, we developed the Post-Stroke Depression toolkit, an evidence-based nurse-led intervention for the early management of depressive symptoms after a stroke for use in the hospital setting. DESIGN: An explanatory mixed-methods before-and-after study design. METHODS: Data were collected continuously from March 2012 - June 2013 during three phases: pre-implementation, the implementation phase (where implementation strategies guided the implementation) and the sustainability phase (executed without the implementation strategies) and involved patient chart audits and surveys and individual and focus group interviews with nurses. RESULTS: A total of 775 patient charts were audited to examine fidelity. Implementation of the Post-Stroke Depression toolkit during the implementation phase resulted in an increase in depression screening (+72.9%) and more patients receiving nursing interventions (+11.1%). During the sustainability phase, screening for depression decreased (-16.3%), while the application of the nursing interventions remained unchanged (+0.6%). The acceptability of the toolkit was judged to be good. CONCLUSIONS: The Post-Stroke Depression toolkit was found to be feasible in terms of fidelity and acceptability, improving structural screening for depressive symptoms as well as the application of nursing interventions in case of a positive screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03500250.

Psychometric evaluation of the Signs of Depression Scale with a revised scoring mechanism in stroke patients with communicative impairment.

OBJECTIVES: To investigate (1) the diagnostic value of the Signs of Depression Scale (SODS) in a Likert scale format and (2) whether the Likert scale improves the diagnostic value compared with the original dichotomous scale. DESIGN: Cross-sectional multicentre study. SETTING: One general and one university hospital in the Netherlands. SUBJECTS: A total of 116 consecutive hospitalized stroke patients, of whom 53 were patients with communicative impairment. MAIN MEASURES: Depression was diagnosed with the Composite International Diagnostic Interview (CIDI) administered to the patients' relatives. The Barthel Index (BI) was used as an external validator. RESULTS: The correlation between the CIDI and the SODS-Likert or the SODS was small ( rb = 0.18), and the correlation between the Barthel Index and the SODS-Likert ( rs = -0.30) or the SODS ( rs = -0.33) was moderate. For both instruments, the discriminatory power for diagnosing depression when compared with the CIDI was best at a cut-off score of ⩾2. The internal consistency of the SODS-Likert was acceptable (α = 0.69) and slightly higher than that of the SODS (α = 0.57). The inter-rater reliability of the SODS-Likert and the SODS was acceptable (intraclass correlation coefficient (ICC) 0.66 and ICC 0.80, respectively). The clinical utility was rated good. CONCLUSION: The diagnostic value of the SODS did not improve using a Likert scale format. However, the diagnostic value of the original dichotomous SODS is reasonable for the initial mood assessment of stroke patients with communicative impairment.

Identifying depression post-stroke in patients with aphasia: a systematic review of the reliability, validity and feasibility of available instruments.

OBJECTIVE: To identify and critically appraise the evidence for instruments assessing depression in stroke patients with aphasia. METHODS: The PubMed, CINAHL, Web of Science, Psych Info and Cochrane databases were searched from inception until May 2015. RESULTS: Of the 383 titles found in the search, 15 articles met the inclusion criteria and six instruments were identified: The Aphasic Depression Rating Scale, the Clinical Global Impression-Scale, the Stroke Aphasic Depression Questionnaire (four versions), the Signs of Depression Scale, the Visual Analogue Mood Scale (three versions) and the Visual Analogue Self Esteem Scale. Supporting evidence for reliability and validity was limited owing to methodological flaws in the studies influencing the ratings of methodological quality. Feasibility data were available for all instruments. Rating time of the instruments ranged from less than one minute to five minutes, two instruments required extensive training. CONCLUSION: A number of instruments to assess depressive symptoms in patients with aphasia are available. None of the instruments however, were found to be sufficiently investigated and most of the studies identified were of low methodological quality. Given the present evidence, the Stroke Aphasic Depression Questionnaire-10, the Stroke Aphasic Depression Questionnaire-H10 and the Signs of Depression Scale are the most feasible and can be recommended for clinical practice.

Psychometric Properties of the Dutch Version of the Signs of Depression Scale.

The early detection of depression after stroke is essential for the optimization of recovery in aphasic stroke patients. The purpose of this study was to evaluate the psychometric properties of the Signs of Depression Scale (SODS), a non-language-based screening instrument. We conducted a cross-sectional study in a sample of 58 stroke patients in a rehabilitation center. The internal consistency and interrater reliability were good (α = .71 and intraclass correlation coefficient [ICC] = .79). The pre-defined hypotheses confirmed the construct validity, and the correlation between the SODS and the Patient Health Questionnaire-9 (PHQ-9) was moderate ( rb = .32). At a cutoff score of ≥1, the sensitivity was 0.80, and the specificity was 0.39. These findings indicate that the SODS is appropriate to screen for depressive symptoms and can be used by nurses to identify symptoms of depression in patients with aphasia who require further assessment.