Abstract
Anxiety is a common and distressing problem after stroke. To undertake an updated systematic review and meta-analysis of observational studies of anxiety after stroke and integrate the findings with those reported previously. Multiple databases were searched in May 2018 and 53 new studies were included following dual independent sifting and data extraction. These were combined with 44 previous studies to form a combined data set of 97 studies, comprising 22,262 participants. Studies using interview methods were of higher quality. Rates of anxiety by interview were 18.7% (95% confidence interval 12.5, 24.9%) and 24.2% (95% confidence interval 21.5, 26.9%) by rating scale. Rates of anxiety did not lower meaningfully up to 24 months after stroke. Eight different anxiety subtypes were also reported. This review confirms that anxiety occurs in around one in four patients (by rating scale) and one in five patients (by interview). More research on anxiety subtypes is needed for an informed understanding of its effects and the development of interventions.
Highlights
Anxiety is a common and distressing problem after stroke
Studies were included if undertaken in populations or groups of patients with a clinical diagnosis of haemorrhagic or ischaemic stroke or transient ischaemic attack (TIA) and were assessed for symptoms of anxiety on a rating scale such as the Hospital Anxiety and Depression Scale (HADS) [9] or were diagnosed by clinical interview
The following results are based on the integrated data set of 97 studies, comprising 44 studies from the original review [11, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58] and 53 studies from the update [59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114]
Summary
A previous systematic review of observational studies [1] included 44 studies published to March 2011 and reported rates of anxiety as 18.3% when diagnosed by interview and 24.3% by rating scale. Summary of review Multiple databases were searched to May 2018 and 53 new studies were included following dual independent sifting and data extraction. Mood problems are common after stroke with reported rates of depression, apathy and distress significantly higher than in the general population [2,3]. A systematic review of observational studies [1] included 44 studies and reported rates of anxiety as 18.3% when diagnosed by interview and 24.3% by rating scale. The review reported that rates lowered with time after stroke, they remained higher than in the general population [4]. Studies had used a number of different scales and cut-off scores to define anxiety, producing considerable uncertainty around the true rate
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