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Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale.
J Psychosom Res. 2009 Oct; 67(4):325-32.JP

Abstract

OBJECTIVE

Anxiety and depression after stroke are frequent, but are often overlooked and not assessed. The aims of the study were to (1) assess the prevalence of anxiety and depression and (2) compare the performance of the Hospital Anxiety and Depression Scale (HADS) and Montgomery and Asberg Depression Rating Scale (MADRS) as screening instruments for anxiety and depression disorders 4 months after stroke.

METHODS

Stroke patients, consecutively admitted to a stroke unit, were assessed with HADS and MADRS 4 months after stroke (n=104). Depression and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV (SCID). Measures were compared in terms of correlations, sensitivity, specificity, positive and negative predictive value, overall agreement, kappa, and ROC curves, using DSM-IV diagnoses of "at least one current significant anxiety disorder" (Anxiety) and "any current depression" (Depression), as the clinical criteria.

RESULTS

Anxiety occurred in 23% of patients and Depression in 19% (13% major depression, 3% minor depression, 4% dysthymia). For Anxiety, the optimal screening cut-off was 4 for HADS-A and 6 for HADS-total; for Depression, optimal cut-offs were 4 for HADS-D, 11 for HADS-total, and 8 for MADRS. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8, MADRS: 12), the MADRS performed marginally better than the HADS.

CONCLUSION

Anxiety is as prevalent as depression 4 months after stroke. MADRS and HADS-D perform acceptably as screening instruments for depression, and HADS-A for anxiety after stroke. However, lower HADS cut-offs than recommended for the general population should be considered for stroke patients.

Authors+Show Affiliations

Department of Behavioral Sciences in Medicine, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway. ulrike.sagen@sthf.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19773025

Citation

Sagen, Ulrike, et al. "Screening for Anxiety and Depression After Stroke: Comparison of the Hospital Anxiety and Depression Scale and the Montgomery and Asberg Depression Rating Scale." Journal of Psychosomatic Research, vol. 67, no. 4, 2009, pp. 325-32.
Sagen U, Vik TG, Moum T, et al. Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. J Psychosom Res. 2009;67(4):325-32.
Sagen, U., Vik, T. G., Moum, T., Mørland, T., Finset, A., & Dammen, T. (2009). Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. Journal of Psychosomatic Research, 67(4), 325-32. https://doi.org/10.1016/j.jpsychores.2009.03.007
Sagen U, et al. Screening for Anxiety and Depression After Stroke: Comparison of the Hospital Anxiety and Depression Scale and the Montgomery and Asberg Depression Rating Scale. J Psychosom Res. 2009;67(4):325-32. PubMed PMID: 19773025.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Asberg depression rating scale. AU - Sagen,Ulrike, AU - Vik,Tom Gunnar, AU - Moum,Torbjørn, AU - Mørland,Tore, AU - Finset,Arnstein, AU - Dammen,Toril, Y1 - 2009/04/17/ PY - 2008/06/20/received PY - 2009/02/24/revised PY - 2009/03/10/accepted PY - 2009/9/24/entrez PY - 2009/9/24/pubmed PY - 2009/12/16/medline SP - 325 EP - 32 JF - Journal of psychosomatic research JO - J Psychosom Res VL - 67 IS - 4 N2 - OBJECTIVE: Anxiety and depression after stroke are frequent, but are often overlooked and not assessed. The aims of the study were to (1) assess the prevalence of anxiety and depression and (2) compare the performance of the Hospital Anxiety and Depression Scale (HADS) and Montgomery and Asberg Depression Rating Scale (MADRS) as screening instruments for anxiety and depression disorders 4 months after stroke. METHODS: Stroke patients, consecutively admitted to a stroke unit, were assessed with HADS and MADRS 4 months after stroke (n=104). Depression and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV (SCID). Measures were compared in terms of correlations, sensitivity, specificity, positive and negative predictive value, overall agreement, kappa, and ROC curves, using DSM-IV diagnoses of "at least one current significant anxiety disorder" (Anxiety) and "any current depression" (Depression), as the clinical criteria. RESULTS: Anxiety occurred in 23% of patients and Depression in 19% (13% major depression, 3% minor depression, 4% dysthymia). For Anxiety, the optimal screening cut-off was 4 for HADS-A and 6 for HADS-total; for Depression, optimal cut-offs were 4 for HADS-D, 11 for HADS-total, and 8 for MADRS. At cut-offs commonly used in clinical practice for depression screening (HADS-D: 8, MADRS: 12), the MADRS performed marginally better than the HADS. CONCLUSION: Anxiety is as prevalent as depression 4 months after stroke. MADRS and HADS-D perform acceptably as screening instruments for depression, and HADS-A for anxiety after stroke. However, lower HADS cut-offs than recommended for the general population should be considered for stroke patients. SN - 1879-1360 UR - https://www.unboundmedicine.com/medline/citation/19773025/Screening_for_anxiety_and_depression_after_stroke:_comparison_of_the_hospital_anxiety_and_depression_scale_and_the_Montgomery_and_Asberg_depression_rating_scale_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3999(09)00091-9 DB - PRIME DP - Unbound Medicine ER -