Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2025; 15(6): 103888
Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.103888
Psychiatric symptoms in stroke patients: Clinical features of depression and anxiety
Jie-Min Li, Su-Sheng Long, Teng-Xiang Lu, Yi-Chun Jiang, Xiao-Wei Zhang, You-Quan Ren
Jie-Min Li, Su-Sheng Long, Xiao-Wei Zhang, You-Quan Ren, Department of Neurology, Linquan People’s Hospital, Fuyang 236400, Anhui Province, China
Teng-Xiang Lu, Department of Hemodialysis Room, Linquan People’s Hospital, Fuyang 236400, Anhui Province, China
Yi-Chun Jiang, Department of Psychiatry, Linquan People’s Hospital, Fuyang 236400, Anhui Province, China
Author contributions: Li JM and Ren YQ conceptualized this study; Ren YQ and Long SS contributed to data collection; Jiang YC and Li JM drafted the initial manuscript, Lu TX and Ren YQ contributed to formal analysis; Li JM and Jiang YC provided guidance and contributed to methodology; Li JM, Jiang YC, Ren YQ, and Zhang XW performed the visualization; Li JM and Ren QY validated this study; all authors participated in this study and jointly reviewed and edited the manuscript.
Supported by the 2023 Fuyang Municipal Scientific Research Projects in Health and Wellness, No. FY2023-0.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Linquan People’s Hospital, approval No. LQYY-2024-014.
Informed consent statement: Informed consent signed by patients and guardians was obtained for this study.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data are not publicly available due to patient privacy restrictions but may be made available from the corresponding author upon reasonable request and with appropriate institutional approvals.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Quan Ren, MD, Chief Physician, Department of Neurology, Linquan People’s Hospital, No. 206 Jianshe South Road, Nanjie Stree, Fuyang 236400, Anhui Province, China. ryq197311@yeah.net
Received: March 12, 2025
Revised: April 11, 2025
Accepted: May 6, 2025
Published online: June 19, 2025
Processing time: 78 Days and 1.2 Hours
Abstract
BACKGROUND

Post-stroke psychiatric complications, particularly depression and anxiety, significantly impact rehabilitation outcomes and quality of life. Despite their prevalence and clinical significance, these conditions often remain underrecognized in routine stroke care. Understanding their clinical features and temporal patterns is crucial for improving patient outcomes.

AIM

To investigate the prevalence, temporal evolution, and clinical correlates of depression and anxiety post-stroke and their impact on functional recovery.

METHODS

In this prospective observational study, 127 patients first-ever ischemic stroke were enrolled between June 2022 and June 2024. Depression and anxiety were assessed using the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale at baseline and follow-up intervals (2 weeks, 1 month, 3 months, and 6 months). Stroke severity was evaluated using the National Institutes of Health Stroke Scale, and functional outcomes were measured using the modified Rankin Scale.

RESULTS

Among 120 patients who completed follow-up (94.5% completion rate), 37.5% had depression (mild: 18.3%, moderate: 12.5%, severe: 6.7%) and 41.7% had anxiety at baseline. Depression prevalence showed a biphasic pattern, peaking at 2 weeks (37.5%), declining at 3 months (28.3%), and slightly increasing at 6 months (30.8%). Stroke severity significantly correlated with both depression (odds ratio = 1.18, 95%CI: 1.06-1.31, P = 0.003) and anxiety (odds ratio = 1.15, 95%CI: 1.04-1.27, P = 0.008). Left hemisphere lesions had a stronger association with psychiatric symptoms than right hemisphere lesions (P = 0.035). Patients with psychiatric complications demonstrated poorer functional outcomes at 6 months (median modified Rankin Scale 3 vs 2, P = 0.015) and longer hospital stays (mean difference: 3.2 days, P = 0.002).

CONCLUSION

Identifying the clinical and neuroanatomical correlates of depression and anxiety will enable effective risk stratification and patient management. Integrating routine psychiatric screening and early intervention is essential in stroke care.

Keywords: Stroke; Depression; Anxiety; Mental health; Functional outcomes; Observational study; Psychiatric symptoms; Rehabilitation

Core Tip: Depression and anxiety are prevalent post-stroke psychiatric complications that significantly affect functional recovery and rehabilitation outcomes. This observational study highlights a biphasic pattern in the prevalence of depression, with the highest incidence at 2 weeks post-stroke. Stroke severity and left hemisphere lesions are closely associated with these psychiatric symptoms. Patients with depression and anxiety showed poorer functional outcomes and longer hospital stays. These findings emphasize the need for early psychiatric screening and intervention in stroke care to improve patient outcomes.