Feasibility of SMS-based screening for mood disturbances after minor stroke: strengths and limitations
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Stroke frequently causes invisible sequelae such as depression, anxiety, fatigue, and cognitive dysfunction that remain underdiagnosed. Simple and accessible screening tools are needed to support their early detection. This study assessed the feasibility and validity of an SMS-based questionnaire in identifying mood disturbances, fatigue and cognitive complaints before follow-up visits around 3-6 weeks post stroke. 100 minor stroke patients responded to SMS questions on mood, fatigue, and cognition starting from 15 days before their follow-up. Responses were compared with validated scales: Hospital Anxiety and Depression (HAD), Center of Epidemiological Studies-Depression (CES-D), Multidimensional Fatigue Inventory (MFI), and Montreal Cognitive Assessment (MoCA). Associations were examined through group comparisons and correlation analyses. Two-thirds of patients responded to at least one SMS, with lower stroke severity predicting higher adherence. Among responders, 37.8% showed probable depression and 34.07% exhibited probable anxiety based on mood scales, and 29.3% reported depression and 29.4% reported anxiety based on SMS responses. SMS-identified depression and anxiety were strongly associated with higher CES-D and HAD scores (p < 0.001). SMS fatigue intensity correlated moderately with fatigue and mood scores. SMS-identified cognitive complaints were associated with higher MFI Mental fatigue scores (p = 0.008) but not with MoCA scores. SMS-based screening appears feasible and useful for detecting mood disturbances after minor stroke but is less suitable for cognitive screening. Larger, more diverse studies with refined measures are required to validate SMS as a scalable post-stroke follow-up tool.
Author Summary
Stroke survivors often experience psychological troubles such as depression, anxiety, and fatigue. While physical impairments may be prioritized by clinicians, these invisible handicaps affect recovery just as much, which is why identifying them quickly and effectively is important. In our study, we selected 100 patients with non-severe strokes who would have a follow-up appointment between 3 and 6 months after stroke. Starting from fifteen days before the follow-up, patients were asked SMS questions if they had specific psychological problems. At the follow-up, patients were given clinical tests to see if their responses matched with the SMS responses they’d given before. This was the case for depression, anxiety, and fatigue, but not so much for cognitive troubles. Overall, our work shows that SMS questionnaires could be used to understand the patient’s mental state after stroke in an easy and accessible way. For patients who find it difficult to come to a hospital for a follow-up, using such surveys could help doctors understand what specific care they need to provide.
