Screening for depression and anxiety after stroke : developing protocols for use in the community

Purpose: To develop screening protocols to detect depression and anxiety after stroke in a community setting and train therapists to administer them. Method: Psychologists and a community therapist met to design a system suitable for screening for anxiety and depression in all those with stroke, including people with cognitive and/or communication problems. Other therapists and a local user group were also consulted. Therapists were then trained in the use of the protocols. The ability to enact the protocols was assessed via case vignettes and staff experience, over a month-long trial. Results: It was considered appropriate for community therapists to screen patients and to do this within 4 weeks of first contact. Two protocols were designed, one for patients without significant communication/cognitive deficits and one for patients with these difficulties. Therapists applied the protocols with accuracy to the case vignettes and rated the training highly. No challenges in applying the protocols in the clinical setting were reported over an initial 1-month trial. Conclusion: Two protocols to screen for depression and anxiety after stroke have been developed. These appear feasible for use when trialled via case vignette and in clinical practice. Further research might consider the usefulness of the screens in detecting actual clinical disorder and developing better screens to identify anxiety after stroke, particularly in those with a cognitive and/or communication disorder. Implications for Rehabilitation Depression and anxiety are common after stroke and likely affect rehabilitation outcomes. These problems can be identified via screening protocols that include measures appropriate for use with those patients having significant cognitive and/or communication disabilities. Rehabilitation therapists can enact these protocols