Regular Research Article
The High Prevalence of Anxiety Disorders After Stroke

https://doi.org/10.1016/j.jagp.2015.06.003Get rights and content

Objectives

Previous studies indicate that post-stroke anxiety is common and persistent. We aimed to determine whether point prevalence of anxiety after stroke is higher than in the population at large, and whether the profile of anxiety symptoms is different.

Methods

This case-control study was conducted in Göteborg, Sweden, with stroke patients recruited from the Sahlgrenska University Hospital and a comparison group selected from local population health studies. We included 149 stroke survivors (assessed at 20 months post-stroke) and 745 participants from the general population matched for age and sex. A comprehensive psychiatric interview was conducted, with anxiety and depressive disorders diagnosed according to DSM-III-R criteria.

Results

Those in the stroke group were significantly more likely than those in the comparison group to have generalized anxiety disorder (GAD) (27% versus 8%), phobic disorder (24% versus 8%) and obsessive-compulsive disorder (9% versus 2%). Multivariate regression indicated that being in the stroke group, female sex, and having depression were all significant independent associates of having an anxiety disorder. In terms of symptom profile, stroke survivors with GAD were significantly more likely to report vegetative disturbance than those in the comparison group with GAD but less likely to have observable muscle tension or reduced sleep.

Conclusions

Point prevalence of anxiety disorders is markedly higher after stroke than in the general population, and this cannot be attributed to higher rates of comorbid depression.

Section snippets

Aims of the Study

Our goal was to investigate the point prevalence of generalized anxiety disorder, phobic disorder, and obsessive-compulsive disorder at 20 months post-stroke, and to delineate the symptom profile in generalized anxiety disorder. The diagnoses of anxiety disorders were made according to DSM-III-R criteria. Participants from the general population with a similar age and sex profile were included as a comparison group. We hypothesised that the stroke group would exhibit higher rates of anxiety

Participants

The stroke patients in this study were recruited consecutively into a naturalistic study examining the effect of stroke unit care. Patients were asked to participate as they were admitted for acute stroke to the Sahlgrenska University Hospital. As well as acute stroke services, this hospital provides secondary and regional care to the surrounding population. We included only patients with completed stroke who were 70 years and older, in an attempt to more closely reflect the population in

Results

From an initial cohort of 243 consecutive hospital-based stroke patients, 149 were investigated after 20 months. Of those patients lost to follow-up, 77 had died and 17 could not be examined. One of these 17 could not be contacted because of unknown address. The other 16 were all contacted but were not willing to participate further, with reasons including language difficulties (N = 4), low mood (N = 3), psychiatric problems other than depression (N = 2), reported forgetfulness (N = 2), and

Discussion

Our data indicate that people who have suffered a stroke are more likely to experience anxiety disorders than people of similar age and sex from the general population. The higher burden of anxiety was found not only for GAD, but also for phobic disorder and obsessive-compulsive disorder. These findings cannot be explained by higher levels of comorbid depression in the stroke sample. Nor can they be simply attributed to disability arising from the stroke, as greater dependence in activities of

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