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Diagnosis and treatment of post-stroke depression in China: a cross-sectional survey of 350 senior clinicians in neurology, geriatrics, and rehabilitation departments

Published online by Cambridge University Press:  03 February 2020

Chunxue Wang
Affiliation:
Department of Neuropsychiatry and Behavioral Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Benyan Luo
Affiliation:
Department of Neurology, The First Affiliated Hospital Zhejiang University, Zhejiang, China
Jian Wu
Affiliation:
Department of Neurology, Beijing Tsing Hua Changgung Hospital, Beijing, China
Wei Pan
Affiliation:
Lundbeck China Medical Affairs Department, Beijing, China
Zheng Li
Affiliation:
Lundbeck China Medical Affairs Department, Beijing, China
Si Luo*
Affiliation:
Lundbeck China Medical Affairs Department, Beijing, China
*
Correspondence should be addressed to: Si Luo, Lundbeck China Medical Affairs Department, Beijing, China. Email: Luos@lundbeck.com.
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Abstract

Type
Letter to the Editor
Copyright
© International Psychogeriatric Association 2020 

Post-stroke depression (PSD) is the most common mood disorder after stroke (Esparrago Llorca et al., Reference Esparrago Llorca, Castilla-Guerra, Fernandez Moreno, Ruiz Doblado and Jimenez Hernandez2015). The diagnosis of PSD can be challenging due to the presence of other stroke-related symptoms (such as difficult concentration, loss of appetite, and sleep disorders) (Rha and Saver, Reference Rha and Saver2007). Although guidelines exist for the diagnosis and treatment of PSD, questionnaire-based surveys of clinicians, nurses, physiotherapists, psychologists, occupational therapists, and other medical staff can provide valuable information about actual clinical practice (Lees et al., Reference Lees, Broomfield and Quinn2014). Therefore, we designed a questionnaire and distributed it to physicians in order to investigate the status of PSD diagnosis and treatment in tertiary hospitals in China.

The questionnaire included 41 entries (Table 1) and was pre-tested in 29 physicians working in different regions of China. Then, 361 physicians were administered this questionnaire. The questionnaire had high reliability (Cronbach’s alpha coefficient = 0.769). The questionnaire has five dimensions that are risk factors of PSD—screening and assessment method, diagnosis status, treatment status, referral, and follow-up status of patients with PSD in China.

Table 1. Questionnaire on the diagnosis and treatment status of post-stroke depression (PSD)

A total of 350 questionnaires were finally analyzed, with 280 (80%) from departments of neurology, 35 (10%) from geriatrics and 35 (10%) from rehabilitation. Almost all physicians believed that a history of stroke could significantly increase the risk of PSD, but some physicians (13%) lacked the knowledge of the available screening methods, particularly those working in geriatrics (31%) and rehabilitation departments (26%). Physicians (87%) would diagnose less than 30% of their stroke patients with PSD. Only 25% of physicians initiated pharmacology therapy immediately after the diagnosis of mild PSD. Most physicians (>70%) considered non-drug therapy as the first option for PSD prophylaxis. The reexamination rate of PSD is not high, ranging from 10% to 60%, and 68% of the patients do not go to review for depression.

The diagnostic rate of PSD was very low in China, mainly because of the complicated condition of some patients, especially those with aphasia and agnosia. Lack of proper diagnostic methods in some hospital departments would also affect the patients’ PSD diagnostic rate. Besides, the physicians’ clinical experience could be an important factor influencing the awareness of the detrimental effects of PSD. Many physicians (≈50%) were inclined to provide non-pharmacologic prophylaxis for PSD in China. Working in cities would also influence the physician’s treatment protocols for PSD. The clinicians surveyed in our study believed that treatment with an antidepressant drug should last at least six months, consistent with international guidelines (Snow et al., Reference Snow, Lascher and Mottur-Pilson2000). The clinicians preferred SSRIs for the pharmacologic management of PSD (Esparrago Llorca et al., Reference Esparrago Llorca, Castilla-Guerra, Fernandez Moreno, Ruiz Doblado and Jimenez Hernandez2015). The review rate of patients with PSD was very low, which emphasizes the need for the implementation of new strategies to improve follow-up.

What we have found in this study provided new insights into current clinical practice regarding the diagnosis and treatment of PSD in China. Our finding also showed that a greater awareness of PSD by neurologists, geriatrics, and rehabilitations is needed to enable them to better diagnose and manage patients with PSD.

Conflict of interest

The authors declare that they have no conflict of interest.

Footnotes

These authors contributed equally to this work.

References

Esparrago Llorca, G., Castilla-Guerra, L., Fernandez Moreno, M. C., Ruiz Doblado, S. and Jimenez Hernandez, M. D. (2015). Post-stroke depression: an update. Neurologia, 30, 2331. doi: 10.1016/j.nrl.2012.06.008.Google ScholarPubMed
Lees, R. A., Broomfield, N. M. and Quinn, T. J. (2014). Questionnaire assessment of usual practice in mood and cognitive assessment in Scottish stroke units. Disability and Rehabilitation, 36, 339343. doi: 10.3109/09638288.2013.791728.CrossRefGoogle ScholarPubMed
Rha, J. H. and Saver, J. L. (2007). The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke, 38, 967973. doi: 10.1161/01.STR.0000258112.14918.24.CrossRefGoogle ScholarPubMed
Snow, V., Lascher, S. and Mottur-Pilson, C. (2000). Pharmacologic treatment of acute major depression and dysthymia. Annals of Internal Medicine, 132, 738742. doi: 10.7326/0003-4819-132-9-200005020-00010.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Questionnaire on the diagnosis and treatment status of post-stroke depression (PSD)

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