Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data
Approximately 30–50% of survivors experience problems with anxiety or depression post-stroke. It is important to understand the factors associated with post-stroke anxiety or depression to identify effective interventions.
Patient-level data from the Australian Stroke Clinical Registry (years 2009–2013), from participating hospitals in Queensland (n = 23), were linked with Queensland Hospital Emergency and Admission datasets. Self-reported anxiety or depression was assessed using the EQ-5D-3L, obtained at 90–180 days post-stroke. Multivariable multilevel logistic regression, with manual stepwise elimination of variables, was used to investigate the association between self-reported anxiety or depression, patient factors and acute stroke processes of care. Comorbidities, including prior mental health problems (e.g. anxiety, depression and dementia) coded in previous hospital admissions or emergency presentations using ICD-10 diagnosis codes, were identified from 5 years prior to stroke event.
2853 patients were included (median age 74; 45% female; 72% stroke; 24% transient ischaemic attack). Nearly half (47%) reported some level of anxiety or depression post-stroke. The factors most strongly associated with anxiety or depression were a prior diagnosis of anxiety or depression [Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95% CI) 1.66–3.39; p < 0.001], dementia (aOR 1.91, 95% CI 1.24–2.93; p = 0.003), being at home with support (aOR 1.41, 95% CI 1.12–1.69; p = < 0.001), and low socioeconomic advantage compared to high (aOR 1.59, 95% CI 1.21–2.10; p = 0.001). Acute stroke processes of care were not independently associated with anxiety or depression.
Identification of those with prior mental health problems for early intervention and support may help reduce the prevalence of post-stroke anxiety or depression.
KeywordsAnxiety Depression Stroke Registries Data linkage Quality of life Comorbidity
We acknowledge members of the Australian Stroke Clinical Registry (AuSCR) Steering Committee, staff from the George Institute for Global Health and the Florey Institute of Neuroscience and Mental Health who manage the AuSCR (Online-Only Data Supplement). We also thank the hospital clinicians (Online-Only Data Supplement) and patients who contribute data to AuSCR. We also acknowledge the data linkage team in Queensland Health (Data Linkage Queensland) who undertook the linkage of data that this study is based on.
The Australian Stroke Clinical Registry (AuSCR) was supported by grants from the National Health and Medical Research Council (NHMRC: 1034415), Monash University, Queensland Health, Victorian Department of Health and Human Services, the Stroke Foundation, Allergan Australia, Ipsen, Boehringer Ingelheim, and consumer donations. TT is supported by the Australian Government Research Training Program Scholarship. The following authors receive Research Fellowship support from the NHMRC: NEA (1072053), MFK (1109426), AGT (1042600), NAL (1112158) and DAC (1063761 co-funded by Heart Foundation).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study as part of the registry.
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