What Australia can learn from overseas guidelines
Depression is a common sequela of stroke, with about 30% of stroke survivors developing depression.1 The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM‐5) recognises post‐stroke depression within the category “Depressive disorder due to another medical condition”.2 Post‐stroke depression significantly hinders patients’ ability to participate in rehabilitation and is associated with poor health outcomes. Despite its high prevalence and negative impact, post‐stroke depression is vastly underdiagnosed.3 One estimate suggested that only 5% of stroke survivors are diagnosed with and treated for depression in routine clinical practice.4 Diagnosis of depression can be challenging in stroke survivors, especially in those who have residual communication and cognitive impairments.
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- 1. Hackett ML, Pickles K. Part I: frequency of depression after stroke: an updated systematic review and meta‐analysis of observational studies. Int J Stroke 2014; 9: 1017–1025.
- 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: APA Publishing, 2013.
- 3. Medeiros GC, Roy D, Kontos N, Beach SR. Post‐stroke depression: a 2020 updated review. Gen Hosp Psychiatry 2020; 66: 70–80.
- 4. Swartz RH, Bayley M, Lanctôt KL, et al. Post‐stroke depression, obstructive sleep apnea, and cognitive impairment: rationale for, and barriers to, routine screening. Int J Stroke 2016; 11: 509–518.
- 5. Ayerbe L, Ayis S, Crichton S, et al. The natural history of depression up to 15 years after stroke: the South London Stroke Register. Stroke 2013; 44: 1105–1010.
- 6. Towfighi A, Ovbiagele B, El Husseini N, et al. Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2017; 48: e30–e43.
- 7. Stroke Foundation. Clinical guidelines for stroke management. Melbourne: Stroke Foundation, 2021. https://informme.org.au/en/Guidelines/Clinical‐Guidelines‐for‐Stroke‐Management (viewed Aug 2021).
- 8. Gilbody S, Sheldon T, House A. Screening and case‐finding instruments for depression: a meta‐analysis. CMAJ 2008; 178: 997–1003.
- 9. Lynch EA, Mackintosh S, Luker JA, Hillier SL. Access to rehabilitation for patients with stroke in Australia. Med J Aust 2019; 210: 21–26. https://www.mja.com.au/journal/2019/210/1/access‐rehabilitation‐patients‐stroke‐australia
- 10. Stroke Foundation. National Stroke Audit: rehabilitation services report 2020. Melbourne: Stroke Foundation, 2016. https://informme.org.au/stroke‐data/Rehabilitation‐audits (viewed Aug 2021).
- 11. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50: e344–e418.
- 12. Heart and Stroke Foundation of Canada. Canadian stroke best practices. Mood, cognition and fatigue following stroke: post stroke depression. www.strokebestpractices.ca/recommendations/mood‐cognition‐and‐fatigue‐following‐stroke/post‐stroke‐depression (viewed Aug 2021).
- 13. Royal College of Physicians. National clinical guideline for stroke. 5th ed. London: RCP, 2016. www.rcplondon.ac.uk/guidelines‐policy/stroke‐guidelines (viewed Aug 2021).
- 14. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th ed. Melbourne: RACGP, 2016. https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048‐Red‐Book‐9th‐Edition.pdf (viewed Aug 2021).
- 15. Colquhoun DM, Bunker SJ, Clarke DM, et al. Screening, referral and treatment for depression in patients with coronary heart disease. Med J Aust 2013; 198: 483–484. https://www.mja.com.au/journal/2013/198/9/screening‐referral‐and‐treatment‐depression‐patients‐coronary‐heart‐disease
Katherine Sewell is the recipient of a La Trobe University postgraduate scholarship for undertaking a PhD, which supported her during the writing of this article.
No relevant disclosures.