Screen for depression in stroke

GPs with an interest in mental health and neurology are recommending that GPs look for depression in patients with stroke, despite these patients being omitted from the new depression quality domain.

Under the revised quality framework, GPs can earn up to eight points for case-finding for depression in patients with diabetes and or heart disease on one occasion during the previous 15 months using the two standard screening questions.

However, no mention is made of case-finding for depression in patients who have suffered a stroke, despite evidence that rates of depression in these patients may be as high as 30 per cent.

A systematic review, carried out by Australian researchers, of 51 studies on post-stroke depression conducted between 1977 and 2002 found that, on average, one in three stroke survivors experienced depression.

The review also found that depression was an important complication of stroke, associated with reduced function and increased cardiovascular events and mortality.

GP Dr Helen Hosker, clinical lead for stroke at Manchester PCT, said: 'I am dismayed that patients who have a stroke will not be included among those who will be screened for depression under the quality framework.'

She said that although the quality framework had improved the management of stroke through its emphasis on hypertension and aftercare, its emphasis on physical risk factors had led many GPs to ignore the psychological consequences of stroke.

Dr Dave Tomson, a Tyneside GP with an interest in mental health, said that excluding stroke patients from this list could be evidence of ageism.

'Just because these people are elderly does not mean that we should not treat their depression,' he said.

He admitted that assessing the mental health of stroke patients could be complicated by difficulties with language and other neurological problems, but said there were tools to help.

'It's not easy, and that's probably one of the reasons it is less done, but it is a key task,' he said.

Dr Alan Cohen, south London GP and director of primary care at the Sainsbury Centre for mental health, which submitted evidence for the quality review, said: 'There are limitations to what can be put in practically. But if the process works well for diabetes and IHD, then it could be extended to cover other disease areas including stroke.'

Aging Health; 2005; 1: 95-105

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