The Prevalence and Predictors of Post-Stroke Depression and Anxiety During COVID-19 Pandemic

Abstract

Introduction Stroke is associated with a rise in post-stroke depression (PSD) and anxiety (PSA). In this study, we evaluated the impact of COVID-19 pandemic on the rates of PSD and PSA. Methods All stroke admissions to two hospitals in Saudi Arabia during two months were prospectively evaluated for PSD and PSA. NIHSS and serum TSH assessed on admission. PSD and PSA were evaluated using Hospital Anxiety and Depression Scale (HADS). Post-stroke disability was assessed by mRS, while social support assessed by Multidimensional Scale of Perceived Social Support (MSPSS). Results Among 50 participants (28 males), clinically significant PSD was found in 36%, while PSA in 32%. PSD associated with higher NIHSS ( P < 0.001); lower MSPSS ( P = 0.003); higher mRS ( P = 0.001); and discontinuation of rehabilitation ( P = 0.02). PSA was associated with higher TSH ( P = 0.01); lower MSPSS ( P = 0.03); while discontinuation of rehabilitation was related to less PSA ( P = 0.034). Multivariate analysis showed that NIHSS (OR: 1.58, 95% CI: 742–3.37; P = 0.01); and MSPSS score (OR: 0.66, 95% CI: 0.47–0.94; P = 0.002) were associated with PSD; while PSA was related to TSH level (OR: 8.32, 95% CI:1.42–47.23; P = 0.02), and discontinuation of rehabilitation (OR: -0.96, 95% CI: -1.90–0.02; P = 0.04). Conclusions Our research shows that the rise in PSD is related to stroke severity and this has not changed significantly during the pandemic; however, PSA showed a noticeable peak. Social deprivation and the lacking levels of rehabilitation related significantly to both.

High Prevalence of Post-stroke Anxiety in Elderly Patients Following COVID-19 Outbreak

“…Compared to the 13.3% incidence of public anxiety in China during the COVID-19 outbreak ( 24 ), the prevalence of PSA with all ages in southern China has been reported between 1.2% and 27% before the COVID-19 pandemic ( 10 , 12 , 25 ). Our study found that 62/206 (30.1%) elderly patients developed PSA, which was higher than that prior to the COVID-19 outbreak but consistent with a recent report of 32% during the pandemic ( 26 ). We also identified fewer hospitalizations of elderly patients with ischemic stroke during the COVID-19 pandemic; this is likely a result of an unwillingness of patients to visit hospitals due to a fear of COVID-19 infection.…”

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

“…Moreover, two other small studies also reported adverse psychological outcomes associated with COVID-19, albeit with significant methodological limitations. Ahmed et al [25] reported significant increase in post-stroke anxiety and depression related to social deprivation, but the study did not include a comparator group, was limited to small study cohort (n = 52) and included a large proportion of patients of Arab origin. Pisano et al [26] also found increased anxiety in aphasic stroke survivors during the pandemic, but this study cohort was not representative of the full stroke population.…”

“…Worryingly, social isolation has adverse effects on rehabilitation compliance, engagement in activities of daily living, anxiety and premature death amongst stroke patients [40][41][42][43]. However, data on how mandatory isolation affects stroke survivor's social participation are extremely limited [7,25]. Potential adverse consequences of decreased social participation include an inability to work with remote technology, lack of face-face contact with social networks, reduction in family roles such as taking care of grand-children, lack of access to daycentres and places of worship [3].…”

Increased Anxiety and Depression Symptoms in Post-Acute Care Patients with Stroke during the COVID-19 Pandemic

“…A depressed or dysphoric mood affects approximately 30% of stroke survivors [ 37 ], reducing the motivation for rehabilitation and promoting poorer functional outcomes or even increased risk for suicide [ 38 , 39 ]. In a recent study, although depression did not significantly worsen, higher rates of anxiety were observed in patients with stroke during the COVID-19 pandemic [ 40 ]. After reviewing our patients’ medical records, we found that the 11 patients were not diagnosed with post-stroke depression during the pandemic.…”