Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke

Well shit, earlier research listed this. So why was this research done? 

Approximately 20% of stroke patients experience clinically significant levels of anxiety at some point after stroke

 

You have a 33% chance of depression after stroke.

 

With your 23% chance of stroke survivors getting PTSD.

 

 The latest here:

Association Between Anxiety, Depression, and Post-traumatic Stress Disorder and Outcomes After Ischemic Stroke

Laura A. Stein¹, Emily Goldmann², Ahmad Zamzam¹, Jean M. Luciano¹, Steven R. Messé¹, Brett L. Cucchiara¹, Scott E. Kasner¹ and Michael T. Mullen^1,3*

• ¹Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
• ²College of Global Public Health, New York University, New York, NY, United States
• ³Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States

Background: Stroke patients are known to be at risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD).

Objective: To determine the overlap between anxiety, depression, and PTSD in patients after stroke and to determine the association between these disorders and quality of life, functional status, healthcare utilization, and return to work.

Methods: A cross-sectional telephone survey was conducted to assess for depression, anxiety, PTSD, and health-related outcomes 6–12 months after first ischemic stroke in patients without prior psychiatric disease at a single stroke center.

Results: Of 352 eligible subjects, 55 (16%) completed surveys. Seven subjects (13%) met criteria for probable anxiety, 6 (11%) for PTSD, and 11 for depression (20%). Of the 13 subjects (24%) who met criteria for any of these disorders, 6 (46%) met criteria for more than one, and 5 (39%) met criteria for all three. There were no significant differences in baseline characteristics, including stroke severity or neurologic symptoms, between those with or without any of these disorders. Those who had any of these disorders were less likely to be independent in their activities of daily living (ADLs) (54 vs. 95%, p < 0.001) and reported significantly worse quality of life (score of 0–100, median score of 50 vs. 80, p < 0.001) compared to those with none of these disorders.

Conclusions: Anxiety, depression, and PTSD are common after stroke, have a high degree of co-occurrence, and are associated with worse outcomes, including quality of life and functional status.

Introduction

Numerous studies have demonstrated that psychiatric symptoms are common after stroke (1). It has been postulated that the sudden onset of neurologic deficits may contribute to distress and anxiety beyond that seen with other acute medical illnesses (2, 3). Although depression has been most studied after stroke, there is an emerging literature on post-stroke anxiety and post-traumatic stress disorder (PTSD). These studies suggest that the post-stroke population has a prevalence of depression, anxiety, and PTSD, occurring in approximately one-quarter to one-third of patients (4–12).

Existing data outside of the stroke population suggest that mental health disorders have a significant impact on patient outcomes including quality of life and mortality (13). In the cardiac literature, depression has been linked to decreased quality of life, and increased all-cause mortality (14–17). Although stroke severity is a major driver of quality of life after stroke, some prior studies have shown reductions in quality of life that are out of proportion to neurologic deficits after stroke (18, 19). Given the relatively high prevalence of anxiety, depression, and PTSD after stroke, it is possible that these disorders are negatively impacting quality of life for these patients. Additionally, studies have linked depression to greater risk of recurrent stroke and death (20, 21).

Co-occurrence of these three mental health disorders is common in the general population, but this has not been well elucidated amongst stroke survivors (22). In one study of stroke patients, having more than one disorder was associated with greater odds of 6-month readmission or death (13). However, while prior studies have looked at outcomes, these studies have had limited data on stroke severity and/or neurologic deficits, which are major potential confounders (11, 23–26).

To that end, we sought to survey patients with first stroke and no reported history of prior psychiatric disease to determine the prevalence of anxiety, depression, and PTSD and the degree of overlap between these conditions. We additionally sought to identify demographic and clinical factors, including detailed information about stroke severity and neurologic deficits, associated with these disorders. Finally, we evaluated the association between these disorders and patient outcomes including return to work, healthcare utilization, self-reported functional outcome, and self-reported quality of life.