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Risk Factors for Symptoms of Depression and Anxiety One Year Poststroke: A Longitudinal Study

Published:February 08, 2016DOI:https://doi.org/10.1016/j.apmr.2016.01.019

      Abstract

      Objective

      To estimate the relative contribution of psychological factors next to sociodemographic and premorbid/stroke-related factors to the risk of developing symptoms of depression and anxiety after stroke.

      Design

      Multicenter, longitudinal cohort study.

      Setting

      Patients after stroke from 6 general hospitals.

      Participants

      Patients (N=331) were included at stroke onset and followed up 2 and 12 months after stroke.

      Interventions

      Not applicable.

      Main Outcome Measures

      Sociodemographic and premorbid/stroke-related information was recorded during hospital admission, whereas psychological characteristics were determined with postal questionnaires 2 months poststroke. Symptoms of depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS) 2 and 12 months poststroke. Multivariable logistic analysis was performed to analyze the influence of sociodemographic, premorbid/stroke-related, and psychological characteristics on depressive symptoms (depression subscale of HADS >7) and symptoms of anxiety (anxiety subscale of HADS >7) 1 year after stroke.

      Results

      Early depression, stroke severity, posterior cerebral artery stroke, and neuroticism independently explained the variance of depressive symptoms 1 year poststroke (discriminative power, 83%; adjusted R2 value, 36%). Neuroticism and early anxiety independently explained the variance of symptoms of anxiety 1 year poststroke (discriminative power, 88%; adjusted R2 value, 44%). Based on these predictive models, nomograms were constructed to visually reflect the individual contribution of each risk factor to the development of long-term mood disorders after stroke.

      Conclusions

      Psychological characteristics are important risk factors for poststroke symptoms of depression and anxiety.

      Keywords

      List of abbreviations:

      AUC (area under the curve), BI (Barthel Index), CI (confidence interval), HADS (Hospital Anxiety and Depression Scale), HADS-A (anxiety subscale of Hospital Anxiety and Depression Scale), HADS-D (depression subscale of Hospital Anxiety and Depression Scale), NIHSS (National Institutes of Health Stroke Scale), OR (odds ratio), UCL-P (Utrecht Coping List passive coping scale), UPCC (Utrecht Proactive Coping Competence list)
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