BACKGROUND: Major depression is common in stroke patients and associated with 
increased rates of disability and mortality. Identifying depression may improve 
mental and physical health. The aim of this review was to determine the most 
accurate tool for detecting poststroke depression.
METHODS: Seven databases were searched up to November 2012. Two authors selected 
studies using International Classification of Disease  or Diagnostic and 
Statistical Manual diagnosis of depression as the reference standard. Two 
authors extracted data and assessed methodological quality. Included studies 
were synthesised using meta-analyses.
RESULTS: A total of 24 included studies provided data on 2907 participants. The 
Center of Epidemiological Studies-Depression Scale (CESD) (sensitivity: 0.75; 
95% CI 0.60 to 0.85; specificity: 0.88; 95% CI 0.71 to 0.95), the Hamilton 
Depression Rating Scale (HDRS) (sensitivity: 0.84; 95% CI 0.75 to 0.90; 
specificity:0.83; 95% CI 0.72 to 0.90) and the Patient Health Questionnaire 
(PHQ)-9 (sensitivity: 0.86; 95% CI 0.70 to 0.94; specificity: 0.79; 95% CI 0.60 
to 0.90) appeared to be the optimal measures for screening measures. However, 
the clinical utility of all tools was modest for case-finding.
INTERPRETATION: There are a number of possible instruments that may help in 
screening for poststroke depression but none are satisfactory for case-finding. 
Preliminary data suggests the CESD, HDRS or the PHQ-9 as the most promising 
options. Although it should be noted such scales should not be used in isolation 
but followed up with a more detailed clinical assessment. While there is 
promising data for the PHQ-2 in other populations, it performed less well than 
other measures.