Abstract
BackgroundMood disorders are commonly seen in those with cerebrovascular disease. Literature to-date has tended to focus on depression and on patients with stroke, with relatively little known about post-stroke anxiety or mood disorder in those with transient ischaemic attack (TIA). We aimed to describe prevalence of depression and anxiety symptoms in stroke and TIA cohorts and to explore association with clinical and socio-demographic factors.MethodsWe used a city wide primary care stroke registry (Glasgow Local Enhanced Service for Stroke - LES). All community dwelling stroke-survivors were included. We described cross-sectional prevalence of depression and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). Data on clinical and demographic details was collected and univariable and multivariable analyses performed to describe associations with HADS scores. We examined those with a diagnosis of ‘stroke’ and ‘TIA’ as separate cohorts.ResultsFrom 13,283 potentially eligible stroke patients in the registry, we had full HADS data on 4,079. Of the 3,584 potentially eligible TIA patients, we had full HADS data on 1,247 patients. Across the stroke cohort, 1181 (29%) had HADS anxiety scores suggestive of probable or possible anxiety; 993 (24%) for depression. For TIA patients, 361 (29%) had anxiety and 254 (21%) had depression. Independent predictors of both depression and anxiety symptoms were female sex, younger age and higher socioeconomic deprivation score (all p < 0.001).ConclusionUsing HADS, we found a high prevalence of anxiety and depression symptoms in a community-based cohort of patients with cerebrovascular disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-014-0198-8) contains supplementary material, which is available to authorized users.
Highlights
Mood disorders are commonly seen in those with cerebrovascular disease
In our stroke-survivor cohort, 604 (15%) of stroke patients were classified as definite abnormal for anxiety symptoms (HADS-A: ≥11) and 577 (14%) were classified as possible abnormal (HADS-A: 8–10); while 458 (11%) were definite abnormal and 535 (13%) were possible abnormal for depression symptoms.(Additional file 1: Table S1 and S2) 1,445 (35%) stroke patients had any mood disorder that comprises of 2,174 caseness for either anxiety or depression
Female sex; younger age; higher level of socioeconomic deprivation (SED); smoking and presence of COPD diagnosis were all strongly associated with higher anxiety and depression scores.(Additional file 1: Figure S1 and S2) On multivariable analysis, sex, age and SED were independently associated with both anxiety and depression symptoms (Additional file 1: Table S3 and S4)
Summary
Literature to-date has tended to focus on depression and on patients with stroke, with relatively little known about post-stroke anxiety or mood disorder in those with transient ischaemic attack (TIA). Mood disorders are common in stroke-survivor cohorts and are associated with increased morbidity and mortality. Meta-analyses of point-prevalence rates suggest one third of stroke-survivors develop post-stroke depression and one quarter develop post-stroke anxiety [1,2]. More than half of stroke survivors will be affected by depression at some point [3] These summary data are important and strongly suggestive of a high stable prevalence of poststroke mood disorder, but meta-analyses are limited by all the caveats that accompany data pooled from various studies and populations. No large study has examined mood problems in both stroke and TIA samples, using an identical assessment procedure, to compare. It seems plausible that the psychological effects of TIA may differ from stroke and a focussed analysis of mood disorder in TIA patients seems warranted
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