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Meta-Analysis
. 2024 Aug 15;24(1):286.
doi: 10.1186/s12883-024-03744-7.

Validity of evaluation scales for post-stroke depression: a systematic review and meta-analysis

Fang Liu  1 , Lei Gong  2 , Huan Zhao  1 , Ying-Li Li  1 , Zhiwen Yan  1 , Jun Mu  3
Affiliations
Meta-Analysis

Validity of evaluation scales for post-stroke depression: a systematic review and meta-analysis

Fang Liu et al. BMC Neurol. .

Abstract

Background: Post-stroke depression (PSD) is closely associated with poor stroke prognosis. However, there are some challenges in identifying and assessing PSD. This study aimed to identify scales for PSD diagnosis, assessment, and follow-up that are straightforward, accurate, efficient, and reproducible.

Methods: A systematic literature search was conducted in 7 electronic databases from January 1985 to December 2023.

Results: Thirty-two studies were included, the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Depression Scale (HDRS) had higher diagnostic accuracy for PSD. The sensitivity, specificity, and diagnostic odds ratio of PHQ-9 or diagnosing any depression were 0.82, 0.87, and 29 respectively. And for HDRS, used for diagnosing major depression, the scores were 0.92, 0.89, and 94. Furthermore, these two scales also had higher diagnostic accuracy in assessing depressive symptoms during both the acute and chronic phases of stroke. In patients with post-stroke aphasia and cognitive impairment, highly diagnostic scales have not been identified for assessing depressive symptoms yet.

Conclusions: The PHQ-9 and HDRS scales are recommended to assess PSD. HDRS, which demonstrates high diagnostic performance, can replace structured interviews based on diagnostic criteria.

Keywords: Depression Scale; Meta-analysis; Post-stroke depression; Validity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of literature screening
Fig. 2
Fig. 2
Risk of bias and fitness bar chart
Fig. 3
Fig. 3
Summary plot of risk of bias and fitness items
Fig. 4
Fig. 4
Forest plot of sensitivity and specificity for each scale. PHQ-9: Patient Health Questionnaire-9. HDRS: Hamilton Depression Scale. MADRS: Montgomery Asberg Depression Rating Scale. BDI: Beck Depression Inventory. GDS: Geriatric Depression Screening Scale. HADS-D: Hospital Anxiety and Depression Scale-Depression. PHQ-2: The Patient Health Questionnaire-2. CES-D: Center for Epidemiological Studies-Depression. HADS: Hospital Anxiety and Depression Scale. PSDS: Post-Stroke Depression Symptom Inventory
Fig. 5
Fig. 5
Prevalence of post-stroke depression in different stroke periods and depression types (forest plots)
See this image and copyright information in PMC

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