Anxiety and depressive symptoms after stroke in 9 rehabilitation centers.

OBJECTIVE: Determine the occurrence of anxiety and depressive symptoms in rehabilitation phase and identify the associated factors that include impact on functional outcome and quality of life in stroke patients.

DESIGN: Prospective analytical study.

MATERIAL AND METHOD: Two hundred fifty one stroke patients from nine rehabilitation centers admitted between March and December 2006 were enrolled into the present study. Anxiety and depressive symptoms were evaluated in stroke patients using the Hospital Anxiety and Depressive Scales (HADS) twice, on admission and at discharge to rehabilitation program. Factors associated with anxiety and depressive symptoms were identified using univariate and multiple logistic regression analyses. Functional ability and quality of life using Barthel ADL Index (BI) and WHOQOL-BREF questionnaires respectively were recorded and analyzed.

RESULTS: Two hundred fifty one patients were assessed for anxiety and depressive symptoms using HADS. It was found that 25.5% of the patients suffered from anxiety symptoms, 37.8% from depressive symptoms, and 17.5% from both. Anxiety symptoms were associated with depressive symptoms (OR 5.49, 95%CI 2.89-10.43) and negatively associated with dyslipidemia (OR 0.48, 95%CI 0.25-0.94). Depressive symptoms were related to anxiety symptoms (OR 5.88, 95%CI 3.15-10.99) and female gender (OR 1.81, 95%CI 1.04-3.16). Patients with anxiety and depressive symptoms had lower functional ability and quality of life than patients without symptoms on admission and at discharge. After the rehabilitation program, patients without anxiety symptoms showed improvement in functional outcome and QOL. However, patients with or without depression symptoms have improvement in functional outcome after rehabilitation. However patients without depressive symptoms showed more items improvement in QOL than patients with depression.

CONCLUSION: Symptoms of anxiety and depression are common after stroke. They are correlated with each other. Female gender also related to depressive symptoms. Patients with anxiety and depressive symptoms have lower functional ability and quality of life than those without symptoms.