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January 24, 2020International Journal of Stroke173 citationsOpen Access

Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies

PKPeter KnappADAlexander Dunn-robertsNSNimah Sahib

Key Result

Anxiety after stroke occurred in 18.7% of patients when diagnosed by clinical interview and 24.2% when assessed by rating scales, with rates remaining stable for years after the event.

Study Design

Type

Meta-Analysis (n=26,262)

Structured PICO

P
Population
26,262 patients with a clinical diagnosis of stroke or TIA from 97 observational studies, assessed for anxiety prevalence up to 10 years post-stroke.
O
Outcome
Prevalence of anxiety after stroke assessed by clinical interview or rating scalepatient reported

Anxiety is highly prevalent after stroke, affecting approximately 1 in 4 patients by rating scale and 1 in 5 by clinical interview, and persists for years.

Limitations

  • Very high levels of heterogeneity among the included studies.
  • Exclusion of studies reporting proxy ratings of anxiety limits external validity for patients with severe cognitive or language impairment.
  • Pooled estimates for some anxiety sub-types were based on small numbers of primary data studies.
  • Combination of a variety of methods, rating scales, and cut-off scores due to pooling whatever was reported in the primary studies.
  • Some pooled estimates based on small numbers of primary studies
  • Very high levels of heterogeneity
  • Exclusion of proxy ratings limits external validity for patients with severe cognitive or language impairment
  • Small numbers of studies reported anxiety sub-types

Abstract

Background Anxiety is a common and distressing problem after stroke. Aims To undertake an updated systematic review and meta-analysis of observational studies of anxiety after stroke and integrate the findings with those reported previously. Summary of review Multiple databases were searched in May 2018 and 53 new studies were included following dual independent sifting and data extraction. These were combined with 44 previous studies to form a combined data set of 97 studies, comprising 22,262 participants. Studies using interview methods were of higher quality. Rates of anxiety by interview were 18.7% (95% confidence interval 12.5, 24.9%) and 24.2% (95% confidence interval 21.5, 26.9%) by rating scale. Rates of anxiety did not lower meaningfully up to 24 months after stroke. Eight different anxiety subtypes were also reported. Conclusions This review confirms that anxiety occurs in around one in four patients (by rating scale) and one in five patients (by interview). More research on anxiety subtypes is needed for an informed understanding of its effects and the development of interventions.

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Cite This Study

Knapp et al. (2020) conducted a meta-analysis in Stroke or transient ischaemic attack (TIA) (n=26,262). Stroke or TIA was evaluated on Prevalence of anxiety diagnosed by clinical interview (95% CI 12.5-24.9). Anxiety after stroke occurred in 18.7% of patients when diagnosed by clinical interview and 24.2% when assessed by rating scales, with rates remaining stable for years after the event.

synapsesocial.com/papers/6a1f53c2019c3aaee5834d48https://doi.org/10.1177/1747493019896958
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