Early detection of patients at risk for anxiety, depression and apathy after stroke

Abstract 

Background and purpose

The aim of this study was to identify clinical factors in the acute stage that can predict anxiety, depression and apathy at 4 months after stroke.

Methods

One hundred four consecutive stroke patients in a stroke unit were assessed within the first 2 weeks and after 4 months. Assessments included anxiety and depression symptoms on the Hospital Anxiety and Depression Scale (HADS) [HADS Anxiety subscale (HADS-A) ≥8 and HADS Depression subscale (HADS-D) ≥8], physical impairment, functional disability, somatic comorbidity upon admission, assessment of apathy (score ≥34 on the Apathy Evaluation Scale) and a psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anxiety disorder (anxiety) or depression (depression) on follow-up. Logistic regression analysis was used to identify factors associated with anxiety, depression and apathy.

Results

Anxiety and depression at 4 months were significantly associated with HADS-A scores of ≥8 upon admission [odds ratio (OR)=4.4; 95% confidence interval (95% CI)=1.7–11.9; P=.003 and OR=2.9; 95% CI=1.0–7.9; P=.043, respectively]. Apathy at 4 months was significantly associated with somatic comorbidity upon admission (OR=3.0; 95% CI=1.0–8.3; P=.036) and had a borderline association with HADS-D scores of ≥8 (OR=8.4; 95% CI=1.0–72.0; P=.051) upon admission.

Conclusion

Assessment with HADS within the first 2 weeks of stroke can contribute to the detection of patients at risk for clinically significant anxiety, depression and apathy at 4 months after stroke.

Keywords: Anxiety, Apathy, Depression, Stroke management, Assessment