The phenomenology of post-stroke depression.

Aims: This portfolio reviews the concept of Post-Stroke Depression (PSD) by exploring differences in the symptoms of depression between stroke survivors and members of the general population. The portfolio focuses on concerns that other stroke symptoms, such as fatigue, might be misinterpreted as depression, or vice versa. Structure: This portfolio includes a systematic review of existing studies that investigated symptom differences between PSD and general population depression. An empirical paper follows, which examined a commonly used depression questionnaire, the Patient Health Questionnaire-9 (PHQ-9) and how it might unintentionally measure stroke symptoms other than depression. This involved Confirmatory Factor Analysis (CFA), a statistical method. The portfolio finishes by reflecting on this research. Results: The systematic review found many similarities in the symptoms of depression between stroke and the general population. It found that loss of interest or pleasure in activity was less common in PSD. It found that problems with changeable emotions and disruption to working were more common in PSD. The empirical paper found that the PHQ-9 measures depression in stroke without problematic effects of other stroke symptoms, but that post-stroke fatigue might raise people’s scores on the question relating to tiredness. Researchers should therefore not compare PHQ-9 scores between stroke and non-stroke groups without accounting for this. Conclusions: We found evidence for similarities and differences in experiences of depression between stroke and non-stroke. Depression measurement was robust to other physical consequences of stroke in both papers, but questionnaire items concerning tiredness and fatigue may be more prone to measuring these problems as well as depression. PSD may therefore be treated similarly to depression in other populations, but with consideration of a person’s experiences of loss, changes to personal roles and work, their mood and well-being, and changes to how quickly their emotions change