Detection of Depression in the Early Stage of Stroke: new opportunities in nursing care

Post stroke depression (PSD) is a common clinical consequence after stroke affecting 33% of all stroke survivors. Depression is negatively associated with functional outcome, length of stay in hospital, cognitive impairment and social activities. In spite of the high prevalence and the huge impact on recovery, PSD remains unrecognized, undiagnosed and under treated. Increasing evidence shows treatment leading to a decrease in depression, and improving patient outcomes. This indicates that an early detection of PSD is essential for the optimization of the recovery of patients with stroke.

In the Nursing Rehabilitation Guideline Stroke (NRGS) recommendations focus on early screening, detection, and nursing interventions for PSD) (1).  Implementing clinical practice guidelines into clinical practice however, is often difficult. Based on this it was decided to develop a toolkit which included screening of PSD and nursing interventions in case of possible depressive symptoms.

About 30% of stroke patients have communicative impairments. For the screening on depressive symptoms in these patients no reliable and valid instrument is available After careful review of the literature the Signs Of Depression Scale (2) was identified as a possible suitable instrument for the assessment of PSD in patients with communicative disorders (3). Therefore, the psychometric properties of the SODS is investigated in the second study.

By conducting these two studies, a) the feasibility of the PSD-toolkit and b) the psychometric properties of the SODS for patients with communicative impairments post stroke, we hope to come to a PSD-toolkit that nurses can use for the identification of PSD in both patients with and without communicative impairments after stroke in the most efficient way.

Study aims

  1. to develop and investigate  the feasibility and sustainability of the PSD-toolkit in the daily nursing care to uncover the strengths and weaknesses of the toolkit, it’s utility and practicality, opportunities and threats of the target group (i.e. nurses), the setting to accept the PSD-toolkit, and the resources needed for a successful implementation (study 1).
  2. to validate the SODS in a population of stroke patients with communicative impairments and to compare it to a gold standard (study 2).

Both studies are  conducted three hospitals in the Utrecht district, one University Hospital and two general hospitals.

(1) Gooskens F, de Man-van Ginkel JM and Schuurmans M: Post Stroke Depression. In: Hafsteinsdóttir TB, Schuurmans MM. Clinical Nursing Rehabilitation Stroke-guideline (CNRS-guideline) [in Dutch]. : Elsevier gezondheidszorg; 2009.  

(2) Hammond MF, O'Keeffe ST, Barer DH. Development and validation of a brief observerÔÇÉrated screening scale for depression in elderly medical patients. Age Ageing 2000;29(6):511.

(3) van Dijk MJ, de Man-van Ginkel JM, Hafsteinsdottir TB, Schuurmans MJ. Identifying depression post-stroke in patients with aphasia: A systematic review of the reliability, validity and feasibility of available instruments. Clin Rehabil 2015 Aug 20.


Van Dijk, M.J., De Man-Van Ginkel, J.M., Hafsteinsdottir, T.B. and Schuurmans, M.J., 2015. Identifying depression post-stroke in patients with aphasia: A systematic review of the reliability, validity and feasibility of available instruments.  Clin Rehabil,  0269215515599665, first published on August 20, 2015.