Introduction: The impact of anxiety, depression, and PTSD on outcome after stroke is incompletely understood. We aim to evaluate the prevalence of these disorders after stroke and evaluate associations with outcomes including healthcare utilization, medication adherence, return to work, and quality of life.
Methods: We performed telephone surveys on stroke patients discharged to home or acute rehabilitation 6-12 months after discharge from a comprehensive stroke center. Patients with preexisting psychiatric disease, prior stroke, and those unable to communicate were excluded. Demographics, including education, relationship status, and household size were recorded. Stroke etiology, location, and severity (NIHSS) were abstracted from medical records. Surveys included: employment status, the Hospital Anxiety and Depression Scale, PTSD Checklist-Stressor Specific Version (PCL-S), Stanford Healthcare Utilization Survey, Morisky Medication Adherence Scale, modified Rankin Scale (mRS) and quality of life (Euro QOL-5D).
Results: Data collection is ongoing. Currently, 36 of 118 eligible subjects completed the survey. Responders and non-responders did not differ by demographic or clinical features. Of the 36 subjects, 31% screened positive for anxiety, depression, or PTSD. Subjects screening positive were similar to those who did not with respect to demographics, stroke etiology and location, and NIHSS (median 2 vs 2, p=0.44). Good functional outcome (mRS 0-2) was less likely in those who screened positive, 55% vs 96%, p=0.01. These subjects were less likely to return to work (14% vs 100%, p<0.001) and reported lower scores on the Euro QOL-5D (any problem with mobility 81% vs 36%, p=0.03; self-care 55% vs 8%, p=0.005; usual activities 82% vs 40%, p=0.031; anxiety/depression 73% vs 16%, p=0.002, and quality of life median 55 vs 80, p=0.002).
Conclusions: Preliminary results show anxiety, depression, and PTSD are common after stroke and are associated with not returning to work, worse functional outcome and quality of life. More research is needed to characterize whether these associations are causal and determine if treating mood disorders can improve outcomes.