Abstract
Background and Purpose. Anxiety affects 25% of stroke survivors. There are no effective treatments. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. We systematically reviewed the literature and performed a meta-analysis to identify associations with these factors. Methods. We searched electronic databases from January 2014 to July 2015 to complement a literature search performed from inception to May 2014. Study quality was assessed using an internationally endorsed checklist. We used odds ratios (ORs) to estimate the strength of associations and random-effects modelling to calculate summary effect sizes. Results. There were 24 studies recruiting 15448 patients. Quality of reporting was satisfactory. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR = 4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. No studies reported on locus of control, coping, or confidence. Conclusion. Poststroke anxiety was associated with depression but there are limited data on other modifiable associations. Further research is needed to identify potential targets for treatment.
Highlights
A clinically significant mental health disorder occurs in greater than one-third of poststroke patients and may be associated with increased morbidity and mortality [1]
Meta-analysis of 13 studies of 2408 patients demonstrated a statistically significant association between poststroke anxiety (PSA) and PSD (OR = 4.66, 95% confidence interval (95% CI) = 2.23–9.74)
Data on association between PSA and cognitive impairment were conflicting. To our knowledge this is the only meta-analysis on the associations of PSA and psychological factors; a systematic review was published previously [7], a metaanalysis was not performed
Summary
A clinically significant mental health disorder occurs in greater than one-third of poststroke patients and may be associated with increased morbidity and mortality [1]. Anxiety following a stroke or transient ischaemic attack (TIA) occurs in about 24% of patients [4] and is a distressing problem associated with poorer health related quality of life [5]. There are no studies on the prevention of PSA [2] and very few randomised trials of intervention to treat it [6] This may partly reflect a lack of data reporting its risk factors and associations. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR = 4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. Further research is needed to identify potential targets for treatment
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