A systematic review reporting on the psychometric properties of the instruments used to diagnose depression post stroke.

Abstract

Post-stroke depression (PSD) is a recognised consequence of stroke, yet the literature shows considerable variation in how PSD is defined, operationalised and measured. These inconsistencies influence prevalence estimates, affect comparability across studies and limit the clinical usefulness of many instruments. This thesis undertook a systematic review and meta-synthesis to identify instruments used to assess PSD in adults and to evaluate the adequacy of their reported psychometric properties. A two-phase search strategy was conducted through the University of the Western Cape’s uKwazi discovery system. The initial search covered studies from 2010 to 2021, followed by a post-conceptualisation update (2022–2025). The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Across both phases, 72 studies were included. Data were extracted on definitions, classification systems, instrument purpose, adaptations, modes of administration, and psychometric properties. Frequently used instruments included the Hamilton Depression Rating Scale and the Structured Clinical Interview for DSM Disorders. Many measures were designed for general depression and applied to stroke populations without stroke-specific validation. Psychometric evidence was inconsistently reported. Internal consistency was common, while test–retest reliability, inter-rater reliability, comprehensive validity evidence, and diagnostic accuracy metrics such as sensitivity and specificity were limited. The findings highlight the need for clearer definitional frameworks and more rigorous validation practices in PSD research. Ethics clearance for this study was granted by the University of the Western Cape Biomedical Research Ethics Committee.