Anxiety and depressive symptoms during hospitalisation are strong predictors of post-stroke anxiety: a prospective study
Stefany Elias A * , Maria Luiza Benevides B , André Martins A , Gladys Martins C , Ana Marcos D and Jean Nunes DA
B
C
D
Abstract
Ischemic stroke is a relevant cause of mortality in Brazil and worldwide. Anxiety symptoms after stroke are frequent and their predictors still need to be elucidated. The present research aims to investigate the frequency and predictors of post-stroke anxiety (PSA).
A prospective cohort study was carried out in a tertiary centre of neurology, including 148 patients with acute ischemic stroke who were interviewed between January 2020 and February 2021. The first interview, during hospitalisation, included the investigation of clinical, sociodemographic, and radiological variables and the application of the Hospital Anxiety and Depression Scale (HADS). Subsequently, the HADS and the modified Rankin Scale were reapplied 90 days after stroke by phone interview. Predictor variables were investigated by applying univariate and multivariate linear regression. Data were expressed by ‘Beta’, ‘R square’ and ‘P’ values. Variables that demonstrated P ≤ 0.20 in the univariate linear regression were included in a multivariate linear regression model.
The frequencies of anxiety symptoms during hospitalisation and 90 days after stroke were high (33.8 and 23.7%, respectively). Anxiety and depressive symptoms during hospitalisation (B: 0.441; P < 0.01 and B: 0.241; P < 0.01, respectively) and depression 90 days after stroke (B: 0.394; P < 0.01) were strong predictors of PSA.
This study identified a high frequency of PSA. Psychiatric symptoms during hospitalisation was demonstrated to be a strong predictor of PSA. This highlights the importance of the early recognition of psychiatric symptoms, even during hospitalisation, to timely treat those patients who might experience a positive impact on their recovery.
Keywords: anxiety, anxiety symptoms, depression, depressive symptoms, ischemic stroke, post-stroke anxiety, post-stroke depression, stroke.
References
Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh 3rd EE (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke 24(1), 35-41.
| Crossref | Google Scholar | PubMed |
Ahmed ZM, Khalil MF, Kohail AM, Eldesouky IF, Elkady A, Shuaib A (2020) The prevalence and predictors of post-stroke depression and anxiety during COVID-19 pandemic. Journal of Stroke and Cerebrovascular Diseases 29(12), 105315.
| Crossref | Google Scholar | PubMed |
Albrecht JS, Peters ME, Smith GS, Rao V (2017) Anxiety and posttraumatic stress disorder among medicare beneficiaries after traumatic brain injury. Journal of Head Trauma Rehabilitation 32(3), 178-184.
| Crossref | Google Scholar | PubMed |
Anker JJ, Kushner MG (2019) Co-occurring alcohol use disorder and anxiety: bridging the psychiatric, psychological, and neurobiological perspectives. Alcohol Research: Current Reviews 40(1), 3.
| Crossref | Google Scholar | PubMed |
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337(8756), 1521-1526.
| Crossref | Google Scholar | PubMed |
Benevides ML, Costa Nunes J, Guarnieri R, Melo H, Lunardi M, Neves Linhares M, Kupek E, Wolf P, Lin K, Walz R (2021) Anxiety and depressive symptoms long after mesial temporal epilepsy surgery: a prospective study. Epilepsy & Behavior 118, 107936.
| Crossref | Google Scholar | PubMed |
Burton CAC, Murray J, Holmes J, Astin F, Greenwood D, Knapp P (2012) Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies. International Journal of Stroke 8(7), 545-559.
| Crossref | Google Scholar |
Chun H-YY, Whiteley WN, Dennis MS, Mead GE, Carson AJ (2018) Anxiety after stroke. Stroke 49(3), 556-564.
| Crossref | Google Scholar | PubMed |
Devinsky O, Barr WB, Vickrey BG, Berg AT, Bazil CW, Pacia SV, Langfitt JT, Walczak TS, Sperling MR, Shinnar S, Spencer SS (2005) Changes in depression and anxiety after resective surgery for epilepsy. Neurology 65(11), 1744-1749.
| Crossref | Google Scholar | PubMed |
GBD 2016 Brazil Collaborators (2018) Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet 392(10149), 760-755.
| Crossref | Google Scholar |
Giacobbe P, Flint A (2018) Diagnosis and management of anxiety disorders. Behavioral Neurology and Psychiatry 24(3), 893-919.
| Crossref | Google Scholar | PubMed |
Hackett ML, Yapa C, Parag V, Anderson CS (2005) Frequency of depression after stroke. Stroke 36(6), 1330-1340.
| Crossref | Google Scholar | PubMed |
Knapp P, Dunn-Roberts A, Sahib N, Cook L, Astin F, Kontou E, Thomas SA (2020) Frequency of anxiety after stroke: an updated systematic review and meta-analysis of observational studies. International Journal of Stroke 15(3), 244-255.
| Crossref | Google Scholar | PubMed |
Krishnamurthi RV, Ikeda T, Feigin VL (2020) Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017. Neuroepidemiology 54(2), 171-179.
| Crossref | Google Scholar | PubMed |
Kuring JK, Mathias JL, Ward L (2018) Prevalence of depression, anxiety and PTSD in people with dementia: a systematic review and meta-analysis. Neuropsychology Review 28(4), 393-416.
| Crossref | Google Scholar | PubMed |
Macrodimitris S, Sherman EMS, Forde S, Tellez-Zenteno JF, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Jetté N (2011) Psychiatric outcomes of epilepsy surgery: a systematic review. Epilepsia 52(5), 880-890.
| Crossref | Google Scholar | PubMed |
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R (2005) Dysphagia after stroke. Stroke 36(12), 2756-2763.
| Crossref | Google Scholar | PubMed |
Menlove L, Crayton E, Kneebone I, Allen-Crooks R, Otto E, Harder H (2015) Predictors of anxiety after stroke: a systematic review of observational studies. Journal of Stroke and Cerebrovascular Diseases 24(6), 1107-1117.
| Crossref | Google Scholar | PubMed |
Ojagbemi A, Akinyemi J, Owolabi M, Akinyemi R, Arulogun O, Gebregziabher M, Akpa O, Olaniyan O, Salako B, Ovbiagele B (2020) Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans. Journal of Stroke and Cerebrovascular Diseases 29(9), 105082.
| Crossref | Google Scholar | PubMed |
Pais-Ribeiro J, Silva I, Ferreira T, Martins A, Meneses R, Baltar M (2007) Validation study of a portuguese version of the hospital anxiety and depression scale. Psychology, Health & Medicine 12(2), 225-237.
| Crossref | Google Scholar | PubMed |
Quinn TJ, Dawson J, Walters MR, Lees KR (2009) Reliability of the modified rankin scale: a systematic review. Stroke 40(10), 3393-3395.
| Crossref | Google Scholar | PubMed |
Rafsten L, Danielsson A, Sunnerhagen KS (2018) Anxiety after stroke: a systematic review and meta-analysis. Journal of Rehabilitation Medicine 50(9), 769-778.
| Crossref | Google Scholar | PubMed |
Reuber M, Andersen B, Elger CE, Helmstaedter C (2004) Depression and anxiety before and after temporal lobe epilepsy surgery. Seizure 13(2), 129-135.
| Crossref | Google Scholar | PubMed |
Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, Hailpern SM, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O’Donnell C, Roger V, Sorlie P, et al. (2008) Heart disease and stroke statistics—2008 Update. Circulation 117(4), e25-e146.
| Crossref | Google Scholar | PubMed |
Sadlonova M, Wasser K, Nagel J, Weber-Krüger M, Gröschel S, Uphaus T, Liman J, Hamann GF, Kermer P, Gröschel K, Herrmann-Lingen C, Wachter R (2021) Health-related quality of life, anxiety and depression up to 12 months post-stroke: influence of sex, age, stroke severity and atrial fibrillation – a longitudinal subanalysis of the find-AFRANDOMISED trial. Journal of Psychosomatic Research 142, 110353.
| Crossref | Google Scholar | PubMed |
Sagen U, Vik TG, Moum T, Mørland T, Finset A, Dammen T (2009) Screening for anxiety and depression after stroke: comparison of the hospital anxiety and depression scale and the Montgomery and Åsberg depression rating scale. Journal of Psychosomatic Research 67(4), 325-332.
| Crossref | Google Scholar | PubMed |
Sanner Beauchamp JE, Casameni Montiel T, Cai C, Tallavajhula S, Hinojosa E, Okpala MN, Vahidy FS, Savitz SI, Sharrief AZ (2020) A retrospective study to identify novel factors associated with post-stroke anxiety. Journal of Stroke and Cerebrovascular Diseases 29(2), 104582.
| Crossref | Google Scholar | PubMed |
Schöttke H, Giabbiconi CM (2015) Post-stroke depression and post-stroke anxiety: prevalence and predictors. International Psychogeriatrics 27(11), 1805-1812.
| Crossref | Google Scholar |
Shah AA, Han JY (2015) Anxiety. Behavioral Neurology and Neuropsychiatry 21, 772-782.
| Crossref | Google Scholar | PubMed |
Shehata GA, El Mistikawi T, Risha AS, Hassan HS (2015) The effect of aphasia upon personality traits, depression and anxiety among stroke patients. Journal of affective disorders 172, 312-314.
| Crossref | Google Scholar | PubMed |
Snaith RP (2003) The hospital anxiety and depression scale. Health and Quality of Life Outcomes 1(1), 29.
| Crossref | Google Scholar | PubMed |
Tiller JWG (2013) Depression and anxiety. Medical Journal of Australia 199(S6), S28-S31.
| Crossref | Google Scholar | PubMed |
World Health Organization – WHO (2019) Global Health Observatory data: World Health Statistics 2019. Available at https://www.who.int/gho/publications/world_health_statistics/2019/en/ [retrieved 1 March 2021]
Xu J, Kochanek KD, Murphy SL, Tejada‐Vera B (2010) Deaths: final data for 2007. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 58(19), 1-19.
| Google Scholar |
Yao M, Li H, Luo Y, Li L, Yu J (2021) High prevalence of post-stroke anxiety in elderly patients following COVID-19 outbreak. Frontiers in Psychiatry 12, 699869.
| Crossref | Google Scholar |