Depression and anxiety at 1- and 12-months post ischemic stroke: methods for examining individual change over time

Suzanne Barker-Collo; Rita Krishnamurthi; Balakrishnan Nair; Anna Ranta; Jeroen Douwes; Valery Feigin

doi:10.1071/IB24025

RESEARCH ARTICLE (Open Access)

Next Contents Vol 25(4)

Depression and anxiety at 1- and 12-months post ischemic stroke: methods for examining individual change over time

Suzanne Barker-Collo

^A ^* , Rita Krishnamurthi ^B , Balakrishnan Nair ^B , Anna Ranta ^C , Jeroen Douwes ^D and Valery Feigin ^B

+ Author Affiliations

- Author Affiliations

^A School of Psychology, University of Auckland, Auckland, New Zealand.

^B National Institute for Stroke and Applied Neuroscience, AUT University, Auckland, New Zealand.

^C Department of Medicine, University of Otago - Dunedin Campus, Dunedin, New Zealand.

^D Research Centre for Hauora and Health, Massey University, Auckland, New Zealand.

^* Correspondence to: s.barker-collo@auckland.ac.nz

Handling Editor: Cynthia Honan

Brain Impairment 25, IB24025 https://doi.org/10.1071/IB24025

Submitted: 28 March 2024 Accepted: 19 November 2024 Published: 5 December 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Depression is commonly studied post stroke, while anxiety is less studied. This study presents prevalence of depression and anxiety at 1- and 12-months post ischemic stroke alongside three methods for examining within-subjects change over time.

Methods

Participants were ischemic stroke patients of the Auckland Regional Community Stroke Study (ARCOS-V) with Hospital Anxiety and Depression Scale data at 1- (n = 343) and 12-months (n = 307). Change over time was examined using within-subjects repeated measures ANOVA, calculation of the Reliable Change Index, and a Sankey diagram of those meeting cut-off scores (>7) for caseness over time.

Results

Using repeated measures ANOVA, depression scores didn’t change significantly over time, while anxiety symptoms decreased significantly. When reliable change was calculated, 4.2% of individuals had reliable decreases in anxiety symptoms, while 5.7% had reliable decreases in depression symptoms. Those who had a reliable decrease in one tended to have a reliable decrease in the other. In the Sankey, the proportion of those meeting the cut-off score for anxiety did not change over time (12.8 and 12.7% at 1- and 12-months), while those meeting the cut-off for depression increased slightly (3.7–4.5%) and those meeting cut-offs for both decreased from 10.4 to 8.1%.

Conclusion

The three methods produced very different findings. Use of cut-off scores is common but has limitations. Calculation of clinically reliable change is recommended. Further work is needed to ensure depression and anxiety are monitored over time post-stroke, and both should be the subject of intervention efforts in both acute and late stages post-stroke.

Keywords: anxiety, clinically reliable change, depression, ischemic stroke, Sankey diagram, within-subject ANOVA.

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