Effect of mood on long-term disability in younger stroke survivors: results from the Psychosocial Outcomes In StrokE (POISE) study

ABSTRACT

Background & Purpose

Anxiety and depression are common among stroke survivors, and their effect on long-term outcome remains unknown in those under 65 years of age. We investigated the association between early anxiety/depression after stroke and 12-month disability, and whether this is modified by sex.

Methods

The Psychosocial Outcomes In StrokE (POISE) study was a prospective observational cohort study that recruited 441 younger (< 65 years) stroke survivors ≤28 days of acute stroke. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and disability using the World Health Organization Disability Assessment Scale version II (WHODAS-II). Associations between baseline anxiety/depression, and disability at 12-months was tested using analysis of covariance. Subgroup analysis was conducted using interaction term.

Results

92 (25%) had anxiety and 53 (14%) depression at baseline. Multivariable models showed significant association between baseline anxiety and 12-month disability (WHODAS-II score 15.24 vs. 11.49, p < .05). Those with anxiety had more impairment in ‘cognition’ (WHODAS-II score 18.26 vs. 8.71, p < .001), ‘getting along’ (WHODAS-II score 11.87 vs. 7.42, p < .05) and ‘participation’ (WHODAS-II score 22.37 vs. 15.92, p < .005) WHODAS-II. No significant relationship was found between baseline depression and long-term disability. There was no differential effect of anxiety by sex found in this study.

Conclusions

Post-stroke anxiety has an adverse effect on disability at one year among young stroke survivors.

KEYWORDS:

• Anxiety
• depression
• function
• disability
• WHODAS-II
• HADS
• stroke
• POISE

Acknowledgments

Concept or design of the work (CL, AVL, DZ, MLH); data analysis (QL); interpretation of data (CL, AVL, DZ, MLH), initial draft (CL, AVL, DZ), revised itfor important intellectual content (DZ, MLH).

Data availability statement

The POISE dataset used for this project is held at The George Institute for Global Health.

Additional information

Funding

This study was funded by the National Health and Medical Research Council (NHMRC) of Australia (APP512429). During the completion of this work, Maree L. Hackett was in receipt of a National Heart Foundation Future Leader Fellowship #100034. No funding bodies had a role in the conduct or reporting of this study.