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Screening for Poststroke Depression Using the Patient Health Questionnaire

de Man-van Ginkel, Janneke M.; Gooskens, Floor; Schepers, Vera P. M.; Schuurmans, Marieke J.; Lindeman, Eline; Hafsteinsdóttir, Thóra B.

Nursing Research:
doi: 10.1097/NNR.0b013e31825d9e9e
Features
Abstract

Background: Although poststroke depression has a significant impact on a patient’s ability to recover after stroke, it is generally not recognized. Structured screening can help nurses identify symptoms of depression in stroke patients. In clinical practice, the utility of an instrument is as importantas its validity and reliability.

Objective: To investigate the reliability, validity, and clinical utility of the nine-item and two-item patient health questionnaires (PHQ-9 and PHQ-2, respectively) in stroke patients in a clinical nursing setting. The results of these questionnaires will be compared against those from the Geriatric Depression Scale.

Methods: The PHQ-9 was administered by 43 ward nurses in 55 patients with an intracerebral hemorrhage or ischemic infarction who were able to communicate adequately. The interrater reliability, test–retest reliability and internal consistency, concurrent validity, diagnostic accuracy, and clinical utility were evaluated.

Results: The interrater reliability (intraclass correlation [ICC] = 0.98, 95% CI [0.96, 0.99]), test–retest reliability (ρSp = 0.75, p < .001), and internal consistency (Cronbach’s α = 0.79) of the PHQ-9 were good. The concurrent validity was moderate for the PHQ-9, with a Pearson’s correlation of .7 (p < .001) and acceptable for the PHQ-2 with a Pearson’s correlation of .8 (p < .01). The optimum cutoff point of the PHQ-9 for major depression was 10 (sensitivity, 100%; specificity,86%; positive predicted value, 50%; and negative predicted value, 100%). For the PHQ-2, the optimum cutoff point was 2 (sensitivity, 100%; specificity, 77%; positive predicted value, 38%; and negative predicted value, 100%).

Discussion: The PHQ is a brief and easy-to-use instrument for nursing practice. It shows good reliability, validity, and clinical utility when used in stroke patients who are able to communicate adequately.

Author Information

Janneke M. de Man-van Ginkel, MSc, RN, is PhD Candidate, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands, and Faculty of Medicine, Clinical Health Sciences, Utrecht University, the Netherlands.

Floor Gooskens, MSc, RN, is Clinical Nurse Specialist, Department of Adult Psychiatry, University Medical Centre Utrecht, the Netherlands, and Faculty of Medicine, Clinical Health Sciences, Utrecht University, the Netherlands.

Vera P. M. Schepers, MD, PhD, is Rehabilitation Physician, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands, and Centre of Excellence for Rehabilitation Medicine, Rehabilitation Centre “De Hoogstraat,” Utrecht, the Netherlands.

Marieke J. Schuurmans, PhD, RN, is Professor of Nursing Science, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands; Faculty of Medicine, Clinical Health Sciences, Utrecht University, the Netherlands; and Department of Healthcare, University of Professional Education Utrecht, the Netherlands.

Eline Lindeman, MD, PhD, is Professor of Rehabilitation Medicine, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands, and Centre of Excellence for Rehabilitation Medicine, Rehabilitation Centre “De Hoogstraat,” Utrecht, the Netherlands.

Thóra B. Hafsteinsdóttir, PhD, RN, is Associate Professor, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands; Faculty of Medicine, Clinical Health Sciences, Utrecht University, the Netherlands; Department of Healthcare, University of Professional Education Utrecht, the Netherlands; and Faculty of Nursing, University of Iceland, Reykjavík, Iceland.

Editor’s note Materials documenting the review process for this article are posted at http://www.nursing-research-editor.com/authors/open.php.

Accepted for publication April 5, 2012.

The authors thank Tim van Nesselrooij, MANP, for his contribution of data collection at the rehabilitation center.

The authors declare no conflict of interest.

Corresponding author: Janneke M. de Man-van Ginkel, MSc, RN, Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, C03.236, Heidelberglaan 100, 3584 XC Utrecht, the Netherlands (e-mail: J.M.deMan@umcutrecht.nl).

© 2012 Lippincott Williams & Wilkins, Inc.