Symptoms of Anxiety and Depression After Ischemic Stroke

Objective

To estimate the prevalence of symptoms of anxiety and depression at 3 months, 1 year, and 3 years after ischemic stroke and assess if these are associated with reduced health-related quality of life (HRQOL) or functional disability.

Design

This study is a retrospective, longitudinal study.

Participants

The participants are patients with first-ever ischemic stroke.

Methods

Mood was assessed using Hospital Anxiety and Depression Scale (HADS), HRQOL was determined using EQ-5D-5L. Modified Rankin Scale (mRS) was used to assess functional disability. Included participants had answered the HADS questionnaire at least once during the follow-up period (3 months, 1 year, and 3 years) of the MIDNOR STROKE study. We used logistic mixed effect regression to estimate the prevalence of symptoms of anxiety and depression, reduced HRQOL and functional disability at the three time points. Next, we also used logistic mixed effect regression with symptoms of anxiety or depression as dependent variable, time point as categorical covariate, reduced HRQOL or functional disability, and its interaction with time as covariates.

Results

In total, 696 participants were included in our study. The prevalence estimates of participants with symptoms of depression were 16.5%, 18.4%, and 18.7% at 3 months, 1 year, and 3 years poststroke, respectively. The estimated prevalences of participants with symptoms of anxiety were 18.3%, 19.8%, and 20.3% at 3 months, 1 year, and 3 years, respectively. Participants with reduced HRQOL or functional disability had a higher risk of having symptoms of depression at 3 months (OR 4.63 [95% CI 2.25–9.81] and OR 4.39 [95% CI 1.83–10.52], respectively), 1 year (OR 5.58 [95% CI 2.86–10.89] and OR 5.43 [95% CI 2.53–11.68], respectively), and 3 years (OR 8.24 [95% CI 3.90–17.41] and OR 6.93 [95% CI 2.98–16.08], respectively). Participants with reduced HRQOL had a higher risk of having symptoms of anxiety at 1 year (OR 3.61 [95% CI 1.72–7.89]), whereas participants with functional disability had a higher risk of having anxiety symptoms at 3 months (OR 3.83 [95% CI 1.30–11.28]), and at 3 years (OR 3.40 [95% CI 1.24–9.36]). Sensitivity analyses with adjustment for age, sex, education, stroke severity, prestroke comorbidity burden, and prestroke cardiovascular disease had only minor effects on the estimates.

Conclusion

The prevalence of both anxiety and depression symptoms increased during the follow-up. HRQOL and functional disability are associated with symptoms of anxiety and depression. In stroke patients, efforts should focus on improving both HRQOL and functional disability as well as treating/monitoring symptoms of anxiety and depression, as these outcomes are closely related.