Research On The Revision And Stardization Of The Hospital Version Stroke Aphasic Depression Questionnaire

Background Post stroke aphasia is the senior nerve dysfunction after cerebral language center damaged caused by acute cerebrovascular diseases, which may show one or a number of dysfunctions in listening, speaking, reading and writing. Aphasia is the main disability caused by stroke, which may affect about one-third of stroke patients. The communication problems caused by aphasia affect the patient's social function and give them heavy psychological burden, which cause a high risk to be post-stroke depression in aphasia patients. Therefore, it is very important to detect depression mood in post-stroke patients with aphasia and give timely treatment.However, patients with aphasia always been excluded in a large number of epidemiological investigations about post-stroke depression. Meantime, the depression mood in patients with aphasia has been ignored. What is more noteworthy is that the current identification of depression in clinical is using clinical interviews and a combination of scale evaluation methods (including self-rating scale and the scale rating by others), all of which have a strong language-dependent, so that do not apply to patients with post-stroke aphasia. Therefore, in order to compensate for the shortcomings of depression test facility in the past, scholars have developed a number of non-language-dependent depression scales for patients with aphasia in clinic by evaluating the depressive behavior as the observation point. Structured Assessment of Depression (SADBD) can provide a comprehensive and reliable patient's emotional state, because of which fully accounts the physical performance of patients with depression and mental performance. It will take 45-60 minutes to complete the scale. SADBD has been proved to be a good reliability and validity. However, SADBD also has many shortcomings, such as:lack of graded about response options; requiring some reading skills and understanding for aphasic patients to complete the scale. The author has emphasized that needs to combine the observed behavior for accurate assessment; Visual analog depression scale (VAMS) has been proved to have good reliability and validity. However, it has been proved that VAMS is not suitable for the assessment of post-stroke depression in Chinese people; Signs of Depression Scale (SODS) assessed by nurses is only to be answered by "yes" or "No". Studies have shown that the scale has a high sensitivity and specificity when the cut-off is 3/4. However, other studies have not reached a satisfactory cut-off. Though a simple and effective method to identify post-stroke depression in patients with communication problem, SODS has not been confirmed the cut-off by precise and convincing information. Therefore, it needs further large sample size of clinical research to be confirmed; The appraisal of Aphasia Depression Scale (ADRS) is from sub-acute stroke patients in neurological rehabilitation ward. ADRS has good reliability and validity. However, there are also some limitations about the scale. For example:(1) the scale is not easy to implement because of requiring be evaluated by trained medical personnel who understand the condition of the disease. (2)The validity assessment of the scale is from sub-acute stroke patients living in neurological rehabilitation ward, so its application to a lesser extent. (3)The results have not been confirmed by other studies; Among them, the widely used scale is the Stroke Aphasic Depression Questionnaire which is developed by Sutcliffe and Lincoln. The greatest advantage of SADQ lies in its assessing depressed mood entirely through the daily behavior by health care workers, so that is apply to the patients who have express or understand problems. SADQ Has been translated into French,Italian,Greek and other versions and has been widely used in scientific research and clinical The original design is the Community version (Stroke Aphasic Depression Questionnaire Community Version, SADQ-C). In order to assess depression mood for hospitalization patients with post-stroke aphasia, the author revised SADQ-C into Hospital version (Stroke Aphasic Depression Questionnaire Hospital Version, SADQ-H). SADQ-H has been confirmed with high reliability and validity from non-aphasia stroke patients, but there is no evidence of the outer remarkable behavior is consistent between aphasia patients and non-aphasia patients. It is necessary to determine the reliability and validity of the questionnaire by using it in aphasia patients. After getting the letter of attorney from Professor Lincoln on September 5, 2008, we revised SADQ-H into Chinese version and applied it on clinical research. The purpose of this study is to confirm the reliability and validity of SADQ-H by using it in post-stroke patients with aphasia and establishing a standardized tool to assess depression mood in aphasia patients after stroke.Object The aim of the study was to translate SADQ-H into Chinese and assess the validity and reliability of Chinese edition of SADQ-H. Meantime, we want to know the cut-off and grade standardization of Chinese version SADQ-H, so as to form an accurate assessment of post-stroke depression in patients with aphasia and to aid of treatment.Methods After getting the written authorization and English version questionnaire from the original author, we translated SADQ-H into Chinese from translation-back-translation-Culture-debugging-preliminary-experiment-modify procedures. We take the patients with post-stroke aphasia who meet the inclusion criteria of hospitalization as the experimental group and non-aphasia post-stroke patient as control group from four top hospitals Neurology or rehabilitation word in Guangzhou from August 2008 to December 2009. We assess the research group of patients with ABC after obtaining informed consent from the patients and their families and according to whether the score in listen to understand pass fifty, we divided research group into group with non-understanding problem and the group with understanding problem. All patients are assessed with SADQ-H by trained medical personnel, some of which will be retested one week later. The group with non-understanding problem and the control group also should be assessed by the 17 version Hamilton Depression Rating Scale (HAMD-17) and the 13 version of the Beck Depression Inventory (BDI-13). It is SPSS13.0 used to complete statistical analysis of the data. The reliability of retest was tested with Pearson correlation coefficients; the reliability of internal consistency was evaluated with Cronbach's alpha coefficient; the content validity was evaluated with whether the research methods and procedures were standard or the content device is reasonable; the structure was validity with factor analysis; the criterion validity was evaluated with correlation coefficient by using HAMD-17 and BDI-13 as the criterion; the discrimination validity was evaluated with independent Sample t Test.71 cases of post-stroke aphasia and 67 cases of post-stroke non-aphasia were assessed by using SADQ-H, and then calculate the total score to compare whether the scores of two populations is statistically significant difference. At the same time, this study also test the cut-off and grade standardization of SADQ-H in post-stroke depression assessment in China aphasia patients by the application of ROC curve.Results①This research formed Chinese version of SADQ-H.②The analysis of the retest reliability of the questionnaire showed the retest coefficient correlation was 0.852 (P＜0.05). The internal consistency analysis showed that the Cronbach's alpha coefficients of the questionnaire was 0.790, demonstrating high internal reliability of the questionnaire.③Results indicated that scores on the SADQ-H were significantly related to HAMD and BDI(r=0.731 to r=0.549, P＜0.05). The validity of this questionnaire showed the construct validity was good as indicated by factor analysis. We got seven factors that explain 66.425%of total variance. The average score of the depression group is high than the non depression group, the difference was significant (r= 5.039, P<0.000), demonstrating high discrimination validity of the questionnaire.④We take HAMD-17and Back-13 as diagnostic criteria to explore the cut-off and grade standardization of SADQ-H by using them in post-stroke patients with aphasia. The result is the Chinese vision SADQ-H has a high sensitivity,specificity when the cutoff is 19, so that 19 is the suitable cut-off to assess post-stroke depression in patients with aphasia. On the score of 19,22,26, SADQ-H has high sensitivity and specificity in evaluating depression of grading in post-stroke patients with aphasia.Conclusions 1. The Chinese version of SADQ-H questionnaire has been formed by validating.2. Chinese version of SADQ-H has good reliability and validity, and can be applied to assess depression for post stroke patients with aphasia in china.3. SADQ-H cutoff of depression assessment studies have shown that there are a high sensitivity and specificity when the questionnaire score is 19. On the score of 19,22, 26, SADQ-H has high sensitivity and specificity in evaluating depression of grading in post-stroke patients with aphasia.