Frequency of Anxiety after Stroke

A Systematic Review and Meta-Analysis of Observational Studies

C Alexia Campbell Burton, Jenny Murray, John Holmes, Felicity Astin, David Greenwood, Peter Knapp

Research output: Contribution to journalReview article

132 Citations (Scopus)

Abstract

Background and purpose
Negative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool.

Summary of review
Databases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I2 statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8–29%, I2 = 97%) and was 25% (95% confidence interval 21–28%, I2 = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale ‘probable’ and ‘possible’ cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13–27%, I2 = 96%) within one-month of stroke; 23% (95% confidence interval 19–27%, I2 = 84%) one to five-months after stroke; and 24% (95% confidence interval 19–29%, I2 = 89%) six-months or more after stroke.

Conclusion
Anxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear.
Original languageEnglish
Pages (from-to)545-559
Number of pages15
JournalInternational Journal of Stroke
Volume8
Issue number7
Early online date27 Sep 2012
DOIs
Publication statusPublished - 1 Oct 2013
Externally publishedYes

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Observational Studies
Meta-Analysis
Anxiety
Stroke
Confidence Intervals
Depression
Anxiety Disorders
Uncertainty
Interviews
Psychology

Cite this

Alexia Campbell Burton, C ; Murray, Jenny ; Holmes, John ; Astin, Felicity ; Greenwood, David ; Knapp, Peter. / Frequency of Anxiety after Stroke : A Systematic Review and Meta-Analysis of Observational Studies. In: International Journal of Stroke. 2013 ; Vol. 8, No. 7. pp. 545-559.
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abstract = "Background and purposeNegative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool.Summary of reviewDatabases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I2 statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18{\%} (95{\%}confidence interval 8–29{\%}, I2 = 97{\%}) and was 25{\%} (95{\%} confidence interval 21–28{\%}, I2 = 90{\%}) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale ‘probable’ and ‘possible’ cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20{\%} (95{\%} confidence interval 13–27{\%}, I2 = 96{\%}) within one-month of stroke; 23{\%} (95{\%} confidence interval 19–27{\%}, I2 = 84{\%}) one to five-months after stroke; and 24{\%} (95{\%} confidence interval 19–29{\%}, I2 = 89{\%}) six-months or more after stroke.ConclusionAnxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear.",
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Frequency of Anxiety after Stroke : A Systematic Review and Meta-Analysis of Observational Studies. / Alexia Campbell Burton, C; Murray, Jenny; Holmes, John; Astin, Felicity; Greenwood, David; Knapp, Peter.

In: International Journal of Stroke, Vol. 8, No. 7, 01.10.2013, p. 545-559.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Frequency of Anxiety after Stroke

T2 - A Systematic Review and Meta-Analysis of Observational Studies

AU - Alexia Campbell Burton, C

AU - Murray, Jenny

AU - Holmes, John

AU - Astin, Felicity

AU - Greenwood, David

AU - Knapp, Peter

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Background and purposeNegative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool.Summary of reviewDatabases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I2 statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8–29%, I2 = 97%) and was 25% (95% confidence interval 21–28%, I2 = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale ‘probable’ and ‘possible’ cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13–27%, I2 = 96%) within one-month of stroke; 23% (95% confidence interval 19–27%, I2 = 84%) one to five-months after stroke; and 24% (95% confidence interval 19–29%, I2 = 89%) six-months or more after stroke.ConclusionAnxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear.

AB - Background and purposeNegative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool.Summary of reviewDatabases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I2 statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8–29%, I2 = 97%) and was 25% (95% confidence interval 21–28%, I2 = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale ‘probable’ and ‘possible’ cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13–27%, I2 = 96%) within one-month of stroke; 23% (95% confidence interval 19–27%, I2 = 84%) one to five-months after stroke; and 24% (95% confidence interval 19–29%, I2 = 89%) six-months or more after stroke.ConclusionAnxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear.

KW - anxiety

KW - epidemiology

KW - meta-analyses

KW - rehabilitation

KW - stroke

KW - systematic review

U2 - 10.1111/j.1747-4949.2012.00906.x

DO - 10.1111/j.1747-4949.2012.00906.x

M3 - Review article

VL - 8

SP - 545

EP - 559

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 7

ER -