The Optimal Timing Of Nurse-driven Depression Identification: 7 Vs. 30-45 Days Post Discharge

Introduction: Post-stroke depression (PSD) is under-recognized and affects the recovery and rehabilitation of stroke patients. PSD affects one-third of stroke survivors, but there is little known when to screen for depressive symptoms. The purpose of this study is to determine the optimal timing of depression screening at 7 days vs. 30-45 days post discharge. Methods: All stroke patients received a phone call from a stroke certified RN (SCRN) to assess depression within 7 days and within 30-45 days post discharge using the Patient Health Questionnaire Screening Tool (PHQ9). Three call attempts were made. Data were analyzed from 2018 to 2020. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored 1-9 received lifestyle modification information, 10-19 were referred to depression care management, 20 and above were referred to psychiatry. The number of patients evaluated and the percentage of those who were referred to specific pathways were assessed. Data were analyzed using a t-test. Results: Stroke subtype were as follows: 17% ICH, 80% ischemic, 2% SAH. 1001 patients were called: 564 at 7 days, 437 at 30-45 days. 421 (75%) at 7 days and 277 (63%) at 30-45 days were reached. 11 (3%) at 7 days, 30 (11%) (p=0.045) at 30-45 days scored ≥10 on the PHQ9. Of those who scored ≥10 on PHQ9, 28 (68%) were female and more than half were over the age of 65. 91% of patients had NIHSS ≤5. Conclusion: A higher percentage of patients with PHQ9 ≥10 was detected within 30-45 days post discharge. The 30-45 day time period is more optimal to detect PSD than the 7-day time period post discharge.