Anxiety and depression after stroke: a 5 year follow-up

Abstract

Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres.

Implications for Rehabilitation

• Depression and anxiety persisted up to 5 years after stroke in about a third of patients.

• Variation in the rates of anxiety and depression between different European centres suggest management policies rather than stroke related factors may determine their persistence.

• The effect of variations in stroke management policies should be investigated.

• Patients’ mood should be monitored over time in order to detect those with late onset mood disorders after stroke.

Keywords::

• Anxiety
• depression
• stroke
• prevalence
• prognosis

Acknowledgements

We would like to acknowledge the help of Esme Worthington in preparing the manuscript.

Declaration of Interest: This article was developed within the framework of the research ‘Collaborative Evaluation of Rehabilitation in Stroke Across Europe (CERISE)’, Quality of Life, key action 6, 2001–2005, contract number QLK6-CT-2001-00170 funded by the European Commission and Sekretariat fϋr Bildung und Forschung SBF (CH). It does not necessarily reflect its views and in no way anticipates the Commission’s future policy in this area. The authors report no declarations of interest.