BACKGROUND AND PURPOSE: Assessing poststroke depression may be complicated by 
aphasia, other cognitive deficits, and several somatic stroke-related symptoms. 
We studied the possible differences in performance of some commonly used 
instruments in screening depression after stroke.
METHODS: We compared the Beck Depression Inventory, Hamilton Rating Scale for 
Depression, Visual Analogue Mood Scale, proxy assessment, and Clinical Global 
Impression of the nursing and study personnel, together with Diagnostic and 
Statistical Manual of Mental Disorders, 3rd Edition, Revised diagnosis, in 
assessing depression after stroke in a follow-up study of 100 patients. The 
patients were studied at 2 weeks and at 2, 6, 12, and 18 months after stroke.
RESULTS: The feasibility rates of all assessment instruments studied were fairly 
similar, but the prevalence rates differed according to the assessment 
instruments, varying from the lowest rates with a Diagnostic and Statistical 
Manual of Mental Disorders, 3rd Edition, Revised-based diagnosis up to 3-fold 
with caregiver ratings. The sensitivity and specificity against the Diagnostic 
and Statistical Manual of Mental Disorders criteria were acceptable with the 
Clinical Global Impression, Beck Depression Inventory, and Hamilton Rating Scale 
for Depression, mostly in the range of 0.70 to 1.00. The caregiver ratings were 
higher than the patient ratings (P<0.001) and correlated with the caregiver's 
own Beck Depression Inventory (0.60 to 0.61, P<0.001). The Visual Analogue Mood 
Scale was not a sensitive instrument (sensitivity, 0.20 to 0.60) and did not 
correlate with the Beck Depression Inventory during the first year after stroke.
CONCLUSIONS: Beck Depression Inventory, Hamilton Rating Scale for Depression, 
and Clinical Global Impression assessment by professionals, in addition to the 
Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised 
diagnosis, are useful in assessing depression, but none of these instruments 
clearly stood apart from the others. Proxy ratings should be used with caution, 
and the use of the Visual Analogue Mood Scale among patients with aphasia and 
other cognitive impairments cannot be recommended.