Is self-reported anxiety or depression between 90-180 days post-stroke associated with patient factors or quality of acute care received?

Abstract

Background: An estimated 30-50% of survivors of stroke experience problems with mood. It is important to understand the factors associated with anxiety/depression post-stroke in order to find ways to reduce their prevalence. Methods: Self-reported anxiety/depression was assessed using the EQ-5D-3L, 90-180 days post-stroke. Patient-level data from the Australian Stroke Clinical Registry (AuSCR), obtained between 2009 and 2013 from participating hospitals in Queensland (n=23), were linked with Queensland Hospital Admission and Emergency datasets. Multivariable logistic regression with manual stepwise elimination of variables and model comparisons using Bayesian statistics, was used to investigate the association between self-reported anxiety/depression and clinical data obtained during their hospitalisations (patient factors and quality of care indicators). Comorbidities, including previous anxiety/depression, were identified using ICD-10 codes from admissions within 5 years prior to the stroke event. Results: 2853 patients were included (median age 74; 45% female; 60% ischaemic stroke). Nearly half (47%) reported some level of anxiety/ depression post-stroke. The factors most strongly associated with anxiety/ depression were prior diagnosis of anxiety/depression (Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95%CI) 1.66-3.39; p<0.001), prior diagnosis of 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 smoking within the last 5 years (aOR 1.31, 95%CI 1.05-1.63; p=0.018). Quality of care indicators were not independently associated with anxiety/depression. Conclusion: In our cohort almost 1 in 2 respondents reported anxiety/ depression. Mood screening and follow-up assessments to those patients at high risk may be important interventions to prevent development of post-stroke anxiety or depression.L618235772 <br />