Abstract W P384: De-Depress: Detection of Post Stroke Depression in the Outpatient Setting; the Interim Analysis

Abstract

Stroke is a major contributor to death and disability. For those who survive the initial incident, post stroke depression (PSD) represents a significant modifiable contributor to morbidity and mortality. The incidence of PSD is estimated between 9-50%, and may be higher as some prior studies have excluded those with communicative or cognitive impairments. We hypothesize that a depression screening program will significantly increase the rate of PSD detection and treatment, and can be implemented at a minimum of cost. Our primary objective is to evaluate the effectiveness and feasibility of initiating a depression screening program in the outpatient clinic of a comprehensive stroke center. Methods: This study is designed as a cross-sectional interventional prospective study with a historical control; divided into two phases. Phase I served as the control, wherein data was derived from a retrospective chart review of all patients newly presenting during 2013 with a diagnosis of ischemic stroke. Those already taking antidepressants or with a known mood disorder were excluded. Phase II began in 3/2014 with the initiation of a depression screen (via two validated screening tools, the Patient Health Questionaire-9 (PHQ-9), and the Aphasia Depression Rating Scale (ADRS)), and is ongoing at this time. Odds ratio, relative risk and absolute risk of a diagnosis of PSD will be calculated using a 2x2 table and the CHI-Squared method and compared with the historical control established in Phase I as well as expected norms. Interim Results: During Phase I, 591 new patient charts were reviewed with 268 qualifying for analysis. A diagnosis of PSD occurred in 13 patients (4.9%). The mean time from stroke to follow up was 5.75 months (1.85 in those diagnosed with PSD and 5.95 in those not diagnosed). Conclusion: Phase I of the De-Depress trial confirms a prevalence of PSD of 4.9% in the outpatient population of the cerebrovascular clinic at a comprehensive stroke center. We hypothesize that this is a result of under-recognition of this common condition, and will evaluate in phase II the effect of a simple depression screening program, implemented at a minimum of cost in time and resources.