Background: Altered mood affects approximately half of all stroke survivors and can develop any time post-stroke. We are piloting a mood screening process for people discharged home after stroke.
Aims: A) To describe the proportion of stroke patients with symptoms of anxiety or depression after discharge and B) to describe the referral process to a clinic newly established by the Psychiatry Service for symptomatic stroke patients.
Methods: Consecutive patients discharged from the John Hunter Hospital (JHH) Neurology Department with a primary or secondary diagnosis of acute stroke (ICD-10: I61, I63, I64) or transient ischemic attack (G45) were included. Screening tools for the patient [Hospital Anxiety and Depression Scale (HADS)] and carer [Behavioural Outcomes of Anxiety (BOA) and Stroke Aphasic Depression Questionnaire- Community Version (SADQ-10)] were administered by mail out approximately four months post-discharge. A list of local mental health services was also provided. Patients above the cut-off for potential mood disorders on any tool (HADS-A≥8; HADS-D≥11, BOA≥14, SADQ-10≥14) were referred to the rapid-referral psychiatry clinic established for this project.
Results: From 15 June (project commencement) to 30 November 2022, 48% (352/ 741) of discharged neurology patients were eligible. As of April 2023, 32% (112/352) of eligible patients had returned the HADS or BOA/ SADQ-10 forms. Forty-one patients (12% of all eligible, 37% of returned forms) were flagged with the Psychiatry Service: 44% (18/ 41) for anxiety, 54% (22/41) for anxiety and depression and one patient with anger management issues that the patient and carer had both documented on their forms. Letters outlining the scores were sent to the GP of the other 63% of patients with returned forms.
Conclusion: The piloted process has identified a high proportion of patients with altered mood; however, the response rate was 32%. We plan to trial contacting patients electronically to hopefully improve response rates.