Dear Ms. Carroll,

I read Ms. Hollenders's article "Screening, Diagnosis, and Treatment of Poststroke Depression," published online on March 25, 2014, with great interest. The article offers detailed information about the significant impact poststroke depression (PSD) has on treatment and recovery of stroke survivors. The article highlights a number of screening tools used by a wide range of medical professions to increase the identification of PSD. I would add one caveat to the section on screening tools. The nine-item Patient Health Questionnaire and the Beck Depression Inventory, commonly used depression screening tools, both include questions that target issues related to sleep, appetite, concentration, decision making, fatigue, and speed of movement, all of which are common consequences of stroke. Unfortunately, some responses to these questions primarily reflect issues common in poststroke survivors rather than depressive symptoms. In addition, and as noted in the article, most depression screening tools were not originally designed for stroke survivors who are frequently left with residual physical and cognitive deficits. This issue also limits the accuracy of PSD screening tools. I highlight these issues for measurement consideration, and they should not diminish the quality and informative nature by which this information on PSD is presented in this article.

Sincerely,

Charles Ellis Jr., PhD

Associate Professor

Medical University of South Carolina

Charleston, SC

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