Predictors of post-stroke depression and anxiety at three months following acute ischemic stroke

BACKGROUND: Post-stroke depression (PSD) and post-stroke anxiety (PSA) are common emotional complications after acute ischemic stroke (AIS). We examined the incidence and risk factors for PSD alone, PSA alone, and their co-occurrence three months post-stroke. METHODS: We included 579 AIS patients who completed the Hospital Anxiety and Depression Scale (HADS) at discharge and 3 months later, using anxiety (HADS-A) and depression (HADS-D) subscales. Forty-one routinely collected parameters were analysed, including cognitive function (Montreal Cognitive Assessment) and oral health (Oral Health Impact Profile-14). Participants were grouped as: A - no PSA/PSD (n = 271), B - PSA only (n = 85), C - PSD only (n = 78), D - both PSA and PSD (n = 145). RESULTS: Compared with Group A, PSA was associated with female sex and anxiety at discharge; PSD with older age, ischemic heart disease, cognitive impairment, depression, and poorer functional outcomes; co-morbid PSA and PSD with female sex, infections, cognitive impairment, anxiety, depression, and worse discharge outcomes. Multivariate analysis showed PSA risk increased with anxiety at discharge (OR = 2.58; 98.3% CI:1.26-5.27), PSD risk with older age (OR = 1.05; 98.2% CI:1.01-1.09) and depression at discharge (OR = 3.99; 98.3% CI:1.61-9.80), and co-morbid risk with both anxiety (OR = 2.43; 98.3% CI:1.28-4.63) and depression at discharge (OR = 2.56; 98.3% CI:1.19-5.50). CONCLUSIONS: Mood disorders affect up to 50% of stroke survivors, with co-morbid PSA and PSD most common. Early anxiety and depression at discharge strongly predict later emotional complications. Routine screening at discharge can identify high-risk patients and enable early interventions. Future studies should develop tailored psychological and rehabilitative strategies, that improve both mental health and functional recovery post-stroke. CLINICAL TRIAL NUMBER: Not applicable.