The course of anxiety symptoms in the 24 months after start of stroke rehabilitation and its relation with psychological care and unmet needs: an observational prospective cohort study

Abstract

Background: Anxiety after stroke is common and has a negative impact on quality of life but might be underdiagnosed or undertreated. Objectives: To describe the course of anxiety symptoms post-stroke, and the relation with psychological care and unmet needs. Methods: In an observational prospective cohort study, patients with stroke completed the Hospital Anxiety and Depression Scale (HADS) at 3, 6, 12 and 24 months after the start of rehabilitation; 1 item about psychological care; and the Longer-Term Unmet Needs after Stroke. Chi-square and Kruskal-Wallis tests were used to compare patients within three different trajectories of anxiety symptoms based on the HADS anxiety subscale: no (all times <8), non-consistent (one to three times >= 8) or persistent anxiety symptoms (all times >= 8). Results: Six hundred and ninety patients were included (37.7% females, median age 62 years). At 3, 6, 12 and 24 months after baseline, 136/612 (22.2%), 129/586 (22.0%), 125/548 (22.8%), and 96/487 (19.7%) patients reported anxiety symptoms, respectively. There were 248/384 (64.6%) patients with no, 97/384 (25.3%) with non-consistent, and 39/348 (10.2%) with persistent anxiety symptoms. A minority of patients with non-consistent or persistent anxiety symptoms received psychological care. They had more unmet needs and more often an unmet need related to mood. Conclusion: The prevalence of post-stroke anxiety remains around 20%, and in 10.2% of patients persistent anxiety symptoms were found. Optimization of screening and treatment seems of value.