Development and validation of a nomogram model for identifying post-stroke anxiety symptoms

doi:10.5498/wjp.122517

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Oct 19, 2026; 16(10): 122517
Published online Oct 19, 2026. doi: 10.5498/wjp.122517

Table 1 Comparison of sociodemographic characteristics between the training and validation sets, n (%)

Category	Validation set (n = 285)	Training set (n = 662)	t/Z/χ²	P value
Sex	-	-	1.78	0.182
Male	192 (67.37)	416 (62.84)	-	-
Female	93 (32.63)	246 (37.16)	-	-
Age (years)	66.00 (59.00, 74.00)	66.00 (58.00, 74.00)	-0.50	0.615
Employment status	-	-	6.49	0.039^a
Employed	39 (13.68)	101 (15.26)	-	-
Retired	107 (37.54)	193 (29.15)	-	-
Unemployed	139 (48.77)	368 (55.59)	-	-
Educational status	-	-	1.23	0.755
Junior high school and below	225 (78.95)	538 (81.39)	-	-
College or university	21 (7.37)	37 (5.60)	-	-
High school or technical secondary school	39 (13.68)	86 (13.01)	-	-

^aP < 0.05.

Full Size Table

Table 2 Comparison of clinical characteristics between the training and validation sets, n (%)

Variables	Validation set (n = 285)	Training set (n = 662)	Z/χ²	P value
NIHSS score	2.00 (1.00, 4.00)	2.00 (1.00, 4.00)	-0.27	0.787
mRS score	2.00 (1.00, 3.00)	2.00 (1.00, 3.00)	-0.26	0.793
Hcy	14.46 (11.18, 17.30)	13.85 (10.73, 17.78)	-0.91	0.363
TSH	2.03 (1.29, 3.36)	1.97 (1.19, 3.05)	-1.19	0.235
CRP	2.73 (1.00, 7.90)	2.70 (1.00, 7.75)	-0.09	0.932
Type of stroke	-	-	2.04	0.154
Ischemic stroke	253 (88.77)	607 (91.69)	-	-
Hemorrhagic stroke	32 (11.23)	55 (8.31)	-	-
TOAST classification	-	-	0.50	0.918
Undetermined etiologies	7 (2.77)	13 (2.15)	-	-
Large vessel atherosclerosis	173 (68.38)	417 (68.93)	-	-
Small vessel occlusion	61 (24.11)	142 (23.47)	-	-
Cardio-embolic source	12 (4.74)	33 (5.45)	-	-
Time since stroke	-	-	0.86	0.652
> 6 months	5 (1.75)	9 (1.36)	-	-
> 7 days ≤ 6 months	155 (54.39)	380 (57.40)	-	-
≤ 7 days	125 (43.86)	273 (41.24)	-	-
Feeling pain after stroke	-	-	0.10	0.754
Yes	25 (8.77)	54 (8.16)	-	-
No	260 (91.23)	608 (91.84)	-	-
Pre-stroke sleep duration	-	-	2.72	0.437
< 5 hours	46 (16.14)	131 (19.79)	-	-
5-6 hours	41 (14.39)	94 (14.20)	-	-
6-7 hours	26 (9.12)	46 (6.95)	-	-
> 7 hours	172 (60.35)	391 (59.06)	-	-
History of hyperlipidemia	-	-	5.79	0.016^a
No	262 (91.93)	572 (86.40)	-	-
Yes	23 (8.07)	90 (13.60)	-	-
History of hemicrania	-	-	0.03	0.862
No	281 (98.60)	650 (98.19)	-	-
Yes	4 (1.40)	12 (1.81)	-	-
Family history of stroke	-	-	1.26	0.262
No	279 (97.89)	639 (96.53)	-	-
Yes	6 (2.11)	23 (3.47)	-	-
Depression	-	-	2.22	0.136
No	252 (88.42)	561 (84.74)	-	-
Yes	33 (11.58)	101 (15.26)	-	-
Anxiety	-	-	2.29	0.13
No	251 (88.07)	558 (84.29)	-	-
Yes	34 (11.93)	104 (15.71)	-	-

^aP < 0.05.

NIHSS: Neurological Institute of Health Stroke Scale; mRS: Modified Rankin Scale; Hcy: Homocysteine; TSH: Thyroid-stimulating hormone; CRP: C-reactive protein; TOAST: Trial of ORG 10172 in Acute Stroke Treatment.

Full Size Table

Table 3 Differences between patients with anxiety and those without anxiety within the training set, n (%)

Variables	No anxiety (n = 563)	Anxiety (n = 99)	Z/χ²	P value
NIHSS score	2.00 (1.00, 4.00)	2.00 (1.00, 4.25)	-0.63	0.53
mRS score	2.00 (1.00, 3.00)	2.00 (2.00, 3.00)	-0.69	0.493
Hcy	13.80 (10.70, 17.72)	14.05 (11.25, 18.20)	-0.53	0.597
TSH	2.00 (1.19, 3.07)	1.82 (1.17, 3.01)	-0.66	0.508
CRP	2.70 (1.00, 7.40)	2.76 (1.00, 11.92)	-1.59	0.111
Age (years)	68.00 (59.00, 75.00)	58.50 (52.00, 66.50)	-5.95	0.01^b
Type of stroke	-	-	6.60	0.01^b
Ischemic stroke	505 (90.50)	102 (98.08)	-	-
Hemorrhagic stroke	53 (9.50)	2 (1.92)	-	-
TOAST classification	-	-	3.19	0.364
Stroke of undetermined etiology	11 (2.19)	2 (1.96)	-	-
Large vessel atherosclerosis	342 (67.99)	75 (73.53)	-	-
Small vessel occlusion	119 (23.66)	23 (22.55)	-	-
Cardio-embolic source	31 (6.16)	2 (1.96)	-	-
Time since stroke	-	-	6.68	0.035^a
> 6 months	6 (1.08)	3 (2.88)	-	-
> 7 days ≤ 6 months	331 (59.32)	49 (47.12)	-	-
≤ 7 days	221 (39.61)	52 (50.00)	-	-
Sex	-	-	0.01	0.938
Male	351 (62.90)	65 (62.50)	-	-
Female	207 (37.10)	39 (37.50)	-	-
Employment status	-	-	16.59	0.01^b
Employed	72 (12.90)	29 (27.88)	-	-
Retired	172 (30.82)	21 (20.19)	-	-
Unemployed	314 (56.27)	54 (51.92)	-	-
Educational attainment	-	-	1.79	0.409
Junior high school and below	459 (82.26)	79 (76.70)	-	-
College or university	30 (5.38)	7 (6.80)	-	-
High school or technical secondary school	69 (12.37)	17 (16.50)	-	-
Feeling pain after stroke	-	-	23.86	0.01^b
Yes	33 (5.91)	21 (20.19)	-	-
No	525 (94.09)	83 (79.81)	-	-
Pre-stroke sleep duration	-	-	12.45	0.006^b
< 5 hours	101 (18.10)	30 (28.85)	-	-
5-6 hours	77 (13.80)	17 (16.35)	-	-
6-7 hours	35 (6.27)	11 (10.58)	-	-
> 7 hours	345 (61.83)	46 (44.23)	-	-
History of hyperlipidemia	-	-	9.44	0.002^b
No	492 (88.17)	80 (76.92)	-	-
Yes	66 (11.83)	24 (23.08)	-	-
History of migraine	-	-	8.37	0.004^b
No	552 (98.92)	98 (94.23)	-	-
Yes	6 (1.08)	6 (5.77)	-	-
Family history of stroke	-	-	21.16	0.01^b
No	547 (98.03)	92 (88.46)	-	-
Yes	11 (1.97)	12 (11.54)	-	-
Depression	-	-	102.79	0.01^b
No	507 (90.86)	54 (51.92)	-	-
Yes	51 (9.14)	50 (48.08)	-	-

^aP < 0.05.

^bP < 0.01.

Full Size Table

Table 4 Univariate regression analysis of post-stroke anxiety symptoms

Variables	β	SE	Z	P value	OR (95%CI)
Age	-0.06	0.01	-5.67	< 0.001^c	0.94 (0.93-0.96)
Type of stroke
Ischemic stroke	-	-	-	-	1.00 (reference)
Hemorrhagic stroke	-1.68	0.73	-2.3	0.021	0.19 (0.04-0.78)
Time since stroke
> 6 months	-	-	-	-	1.00 (reference)
> 7 days ≤ 6 months	-1.22	0.72	-1.68	0.093	0.30 (0.07-1.22)
≤ 7 days	-0.75	0.72	-1.04	0.298	0.47 (0.11-1.94)
Employment status
Employed	-	-	-	-	1.00 (reference)
Retired	-1.19	0.32	-3.74	< 0.001^c	0.30 (0.16-0.57)
Unemployed	-0.85	0.26	-3.21	0.001^c	0.43 (0.25-0.72)
Feeling pain after stroke
Yes	-	-	-	-	1.00 (reference)
No	-1.39	0.3	-4.59	< 0.001^c	0.25 (0.14-0.45)
Pre-stroke sleep duration
< 5 hours	-	-	-	-	1.00 (reference)
5-6 hours	-0.3	0.34	-0.87	0.382	0.74 (0.38-1.45)
6-7 hours	0.06	0.4	0.14	0.889	1.06 (0.48-2.33)
> 7 hours	-0.8	0.26	-3.07	0.002^b	0.45 (0.27-0.75)
History of hyperlipidemia
No	-	-	-	-	1.00 (reference)
Yes	0.8	0.27	3.01	0.003^b	2.24 (1.32-3.77)
History of migraine
No	-	-	-	-	1.00 (reference)
Yes	1.73	0.59	2.94	0.003^b	5.63 (1.78-17.82)
Family history of stroke
No	-	-	-	-	1.00 (reference)
Yes	1.87	0.43	4.32	< 0.001^c	6.49 (2.78-15.14)
Depression
No	-	-	-	-	1.00 (reference)
Yes	2.22	0.25	9.05	< 0.001^c	9.20 (5.69-14.88)

^bP < 0.01.

^cP < 0.001.

All categorical variables were treated as dummy variables in logistic regression models. The reference group for each categorical predictor is marked as 1.00 (reference) within the table rows, and summarized as follows: (1) Type of stroke: Ischemic stroke; (2) Time since stroke: > 6 months; and (3) Employment status: Employed. Feeling pain after stroke: Yes. β: Regression coefficient; SE: Standard error; Z: Statistical quantity; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Table 5 Multivariate regression analysis of post-stroke anxiety symptoms

Variables	β	SE	Z	P value	OR (95%CI)
Age	-0.08	0.02	-5.24	< 0.001^c	0.92 (0.89-0.95)
Type of stroke
Ischemic stroke	-	-	-	-	1.00 (reference)
Hemorrhagic stroke	-2.15	0.81	-2.66	0.008^b	0.12 (0.02-0.57)
Time since stroke
> 6 months	-	-	-	-	1.00 (reference)
> 7 days ≤ 6 months	-1.46	0.94	-1.54	0.122	0.23 (0.04-1.48)
≤ 7 days	-0.85	0.95	-0.89	0.371	0.43 (0.07-2.74)
Employment status
Employed	-	-	-	-	1.00 (reference)
Retired	0.14	0.48	0.29	0.769	1.15 (0.45-2.96)
Unemployed	0.44	0.38	1.15	0.249	1.55 (0.74-3.26)
Central post-stroke pain
Yes	-	-	-	-	1.00 (reference)
No	-1.56	0.38	-4.12	< 0.001^c	0.21 (0.10-0.44)
Pre-stroke sleep duration
< 5 hours	-	-	-	-	1.00 (reference)
5-6 hours	-0.32	0.42	-0.75	0.452	0.73 (0.32-1.67)
6-7 hours	-0.04	0.53	-0.07	0.947	0.97 (0.34-2.73)
> 7 hours	-0.49	0.33	-1.46	0.143	0.62 (0.32-1.18)
History of hyperlipidemia
No	-	-	-	-	1.00 (reference)
Yes	0.6	0.34	1.8	0.071	1.83 (0.95-3.53)
History of migraine
No	-	-	-	-	1.00 (reference)
Yes	0.21	0.74	0.28	0.777	1.23 (0.29-5.21)
Family history of stroke
No	-	-	-	-	1.00 (reference)
Yes	1.24	0.56	2.22	0.026^a	3.47 (1.16-10.37)
Depression
No	-	-	-	-	1.00 (reference)
Yes	2.4	0.31	7.86	< 0.001^c	11.03 (6.07-20.07)

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Full Size Table

Citation: Luo SY, Feng L, Hong YJ, Liang J, Peng Y, Shao LH, Zhang XB. Development and validation of a nomogram model for identifying post-stroke anxiety symptoms. World J Psychiatry 2026; 16(10): 122517
URL: https://www.wjgnet.com/2220-3206/full/v16/i10/122517.htm
DOI: https://dx.doi.org/10.5498/wjp.122517

Luo SY, Feng L, Hong YJ, Liang J, Peng Y, Shao LH, Zhang XB. Development and validation of a nomogram model for identifying post-stroke anxiety symptoms. World J Psychiatry 2026; 16(10): 122517 [DOI: 10.5498/wjp.122517]

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