Depression, Anxiety Affect Functional Outcome After Stroke, TIA

The psychological consequences of stroke appear to influence outcomes.

Patients who develop ischemic stroke at a young age may have a higher risk for anxiety, depression, and poor functional outcomes.

In the study, which was published in the European Journal of Neurology, Noortje A. M. M. Maaijwee, of the Department of Neurology at Donders Institute for Brain, Cognition, and Behavior at Nijmegen Medical Center in the Netherlands, and colleagues sought to assess the prevalence of anxiety and depression in participants’ aged 18 to 50 years old with a history of ischemic stroke or transient ischemic attack (TIA). The investigation was a continuation of the Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation (FUTURE) study.

Participants were assessed using the Hospital Anxiety and Depression scale, the modified Rankin Score (mRS) for functional outcomes, and the Instrumental Activities of Daily Living scale (IADL). The study included 511 participants (mean age 40 years), 36.4% of whom were diagnosed with TIA and 63.4% with ischemic stroke. Follow up occurred over an average of 8.3 years and 10.6 years for participants with TIA and stroke, respectively.

The overall prevalence of depression was 16.8%, with a 12.1% prevalence in participants with TIA (OR 2.8, 95% CI 1.2-6.6, P=.02) and 19.5% in participants with stroke (OR 4.7, 95% CI: 2.0-11.0, P=.003) compared to 6.1% in controls.

Multiple regression analysis revealed a higher risk for depression symptoms with unemployment (OR 3.8, 95% CI: 1.9-7.7, P<.001) and lower levels of education in stroke patients (OR 4.3, 95% CI: 2.0-9.0, The overall prevalence of anxiety was 23%, with a 23.1% prevalence in participants with TIA (OR 3.0, 95% CI: 1.6-5.8, P=.001) and 23% in participants with stroke (OR 2.9, 95% CI: 1.5-5.8, P=.002) compared to 12.2% in controls. Multiple regression analysis revealed a higher risk for anxiety in stroke participants with depression (OR 4.3, 95% CI: 2.1-8.8, P<.001) and lower levels of education (OR 3.3, 95% CI: 1.5-7.4, P=.003). Likewise, the risk for anxiety was higher in those reporting alcohol use (OR 4.1, 95% CI: 1.1-15.9, P=.04) and unemployment (OR 2.3, 95% CI: 1.1-4.8, P=.03).

Both depression and anxiety were tied to poor functional outcome as measured by the mRS (OR 11.2, P<.001; OR: 6.4, P<.001, respectively) and the IADL (OR 3.8, P=.002; OR: 2.4, P=.04, respectively).

“The findings of our study indicate that, even more than 10 years after the stroke at young age, lives of the survivors are very much influenced by the psychological consequences of the stroke,” the authors wrote. “These negative effects may be influenced by changing lifestyles and learning better coping strategies.”


Maaijwee NA, Tendolkar I, Rutten-jacobs LC, et al. Long-term depressive symptoms and anxiety after transient ischaemic attack or ischaemic stroke in young adults. Eur J Neurol. 2016; doi: 10.1111/ene.13009.