Clinical impact of a poststroke depression screening program.

Abstract

Background: The potential clinical impact of routine proactive detection and early intervention for poststroke depression (PSD) is currently unknown, despite broad evidence of the adverse impact of PSD on stroke outcomes.

Objective: To measure the impact of a clinical service for routine poststroke depression (PSD) screening and intervention (Effective Mood Management After Stroke [EMMAS]) on the long-term outcomes of survivors of stroke.

Design: Cross-sectional case-control comparison of propensity-score matched samples of patients with stroke.

Setting: Tertiary hospital inpatient rehabilitation setting.

Patients: A sample of patients with a diagnosis of stroke from preimplementation and a sample from postimplementation of EMMAS.

Outcome measure: Poor long-term outcome was defined as a composite of death, institutionalization, requiring a full-time caregiver, or screening positive for depression at >5 years after stroke.

Results: Matched samples (n=115) were identified and matched on demographics and stroke characteristics including severity. In the fully adjusted logistic regression for poor outcomes, patients from the EMMAS program were found to have a significantly lower odds of developing poor outcomes in the long term (odds ratio [OR], 0.37 [95% CI, 0.203-0.654], p < .001).

Conclusion: Routine in-hospital screening and early intervention for PSD has the potential to improve long-term outcomes of survivors of stroke regardless of PSD diagnosis. All patients with stroke can potentially benefit from such an integrated model of care. Further cost-effectiveness analyses are required.