Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.103888
Revised: April 11, 2025
Accepted: May 6, 2025
Published online: June 19, 2025
Processing time: 78 Days and 1.2 Hours
Post-stroke psychiatric complications, particularly depression and anxiety, significantly impact rehabilitation outcomes and quality of life. Despite their prevalence and clinical significance, these conditions often remain underrecognized in routine stroke care. Understanding their clinical features and temporal patterns is crucial for improving patient outcomes.
To investigate the prevalence, temporal evolution, and clinical correlates of depression and anxiety post-stroke and their impact on functional recovery.
In this prospective observational study, 127 patients first-ever ischemic stroke were enrolled between June 2022 and June 2024. Depression and anxiety were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale at baseline and follow-up intervals (2 weeks, 1 month, 3 months, and 6 months). Stroke severity was evaluated using the National Institutes of Health Stroke Scale, and functional outcomes were measured using the modified Rankin Scale.
Among 120 patients who completed follow-up (94.5% completion rate), 37.5% had depression (mild: 18.3%, moderate: 12.5%, severe: 6.7%) and 41.7% had anxiety at baseline. Depression prevalence showed a biphasic pattern, peaking at 2 weeks (37.5%), declining at 3 months (28.3%), and slightly increasing at 6 months (30.8%). Stroke severity significantly correlated with both depression (odds ratio = 1.18, 95%CI: 1.06-1.31, P = 0.003) and anxiety (odds ratio = 1.15, 95%CI: 1.04-1.27, P = 0.008). Left hemisphere lesions had a stronger association with psychiatric symptoms than right hemisphere lesions (P = 0.035). Patients with psychiatric complications demonstrated poorer functional outcomes at 6 months (median modified Rankin Scale 3 vs 2, P = 0.015) and longer hospital stays (mean difference: 3.2 days, P = 0.002).
Identifying the clinical and neuroanatomical correlates of depression and anxiety will enable effective risk stratification and patient management. Integrating routine psychiatric screening and early intervention is essential in stroke care.
Core Tip: Depression and anxiety are prevalent post-stroke psychiatric complications that significantly affect functional recovery and rehabilitation outcomes. This observational study highlights a biphasic pattern in the prevalence of depression, with the highest incidence at 2 weeks post-stroke. Stroke severity and left hemisphere lesions are closely associated with these psychiatric symptoms. Patients with depression and anxiety showed poorer functional outcomes and longer hospital stays. These findings emphasize the need for early psychiatric screening and intervention in stroke care to improve patient outcomes.