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) > or = 8 and HADS Depression subscale (HADS-D) > or = 8], physical impairment, functional disability, somatic comorbidity upon admission, assessment of apathy (score > or = 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 > or = 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 > or = 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.