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PHQ-9, poststroke depression, screening, sensitivity, specificity, stroke



  1. Trotter, Tanya L.
  2. Denny, Dawn L.
  3. Evanson, Tracy A.


ABSTRACT: Background: Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. Methods: Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. Results: Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. Conclusion: Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.