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Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression

Trotter, Tanya L.; Denny, Dawn L.; Evanson, Tracy A.

Journal of Neuroscience Nursing: June 2019 - Volume 51 - Issue 3 - p 147–152
doi: 10.1097/JNN.0000000000000442
Literature Review

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.

Questions or comments about this article may be directed to Tanya L. Trotter, MSN APRN PHCNS-BC, at She is a Doctoral Student at the University of North Dakota, Grand Forks, ND.

Dawn L. Denny, PhD RN ONC, is Assistant Professor, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND.

Tracy A. Evanson, PhD RN PHNA-BC, is Professor and Director of PhD Program in Nursing, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND.

The authors declare no conflicts of interest.

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© 2019 American Association of Neuroscience Nurses