Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Jan;68(1):47–52. doi: 10.1136/jnnp.68.1.47

Emotional outcomes after stroke: factors associated with poor outcome

M Dennis 1, S O'Rourke 1, S Lewis 1, M Sharpe 1, C Warlow 1
PMCID: PMC1760616  PMID: 10601401

Abstract

OBJECTIVES—The impact of stroke on the emotional outcome of patients is large. The aim was to describe the emotional outcomes among a cohort of patients which was of sufficient size to provide a precise estimate of their frequency and help identify those factors which are associated with poor outcomes after an acute stroke.
METHODS—372 surviving patients, who had been referred to a hospital and entered into a randomised trial to evaluate a stroke family care worker, were asked to complete questionnaires at a 6 month follow up. These included measures of emotional distress (general health questionnaire 30 item, hospital anxiety and depression scale) and physical functioning (modified Rankin, Barthel index). A regression analysis was used to identify factors which were independently associated with poor outcomes.
RESULTS—184 (60%) surviving patients scored more than 4 on the GHQ-30, 55 (22%) more than 8 on the HAD anxiety subscale, and 49 (20%) more than 8 on the HAD depression subscale. Patients with severe strokes resulting in physical disability were more likely to be depressed whereas there was a less strong relation between disability and anxiety. Patients with posterior circulation strokes had consistently better emotional outcomes than those with anterior circulation strokes.
CONCLUSIONS—These data may help identify those patients at greatest risk of poor emotional outcomes and thus help in planning trials and delivering appropriate interventions. 



Full Text

The Full Text of this article is available as a PDF (93.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen G., Vestergaard K., Ingemann-Nielsen M., Lauritzen L. Risk factors for post-stroke depression. Acta Psychiatr Scand. 1995 Sep;92(3):193–198. doi: 10.1111/j.1600-0447.1995.tb09567.x. [DOI] [PubMed] [Google Scholar]
  2. Aström M. Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke. 1996 Feb;27(2):270–275. doi: 10.1161/01.str.27.2.270. [DOI] [PubMed] [Google Scholar]
  3. Bamford J. M., Sandercock P. A., Warlow C. P., Slattery J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1989 Jun;20(6):828–828. doi: 10.1161/01.str.20.6.828. [DOI] [PubMed] [Google Scholar]
  4. Bamford J., Sandercock P., Dennis M., Burn J., Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991 Jun 22;337(8756):1521–1526. doi: 10.1016/0140-6736(91)93206-o. [DOI] [PubMed] [Google Scholar]
  5. Burvill P. W., Johnson G. A., Jamrozik K. D., Anderson C. S., Stewart-Wynne E. G., Chakera T. M. Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry. 1995 Mar;166(3):320–327. doi: 10.1192/bjp.166.3.320. [DOI] [PubMed] [Google Scholar]
  6. Burvill P., Johnson G., Jamrozik K., Anderson C., Stewart-Wynne E. Risk factors for post-stroke depression. Int J Geriatr Psychiatry. 1997 Feb;12(2):219–226. doi: 10.1002/(sici)1099-1166(199702)12:2<219::aid-gps581>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  7. Castillo C. S., Schultz S. K., Robinson R. G. Clinical correlates of early-onset and late-onset poststroke generalized anxiety. Am J Psychiatry. 1995 Aug;152(8):1174–1179. doi: 10.1176/ajp.152.8.1174. [DOI] [PubMed] [Google Scholar]
  8. Castillo C. S., Starkstein S. E., Fedoroff J. P., Price T. R., Robinson R. G. Generalized anxiety disorder after stroke. J Nerv Ment Dis. 1993 Feb;181(2):100–106. doi: 10.1097/00005053-199302000-00005. [DOI] [PubMed] [Google Scholar]
  9. Dennis M., O'Rourke S., Slattery J., Staniforth T., Warlow C. Evaluation of a stroke family care worker: results of a randomised controlled trial. BMJ. 1997 Apr 12;314(7087):1071–1077. doi: 10.1136/bmj.314.7087.1071. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Ebrahim S., Barer D., Nouri F. Affective illness after stroke. Br J Psychiatry. 1987 Jul;151:52–56. doi: 10.1192/bjp.151.1.52. [DOI] [PubMed] [Google Scholar]
  11. Herrmann N., Black S. E., Lawrence J., Szekely C., Szalai J. P. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome. Stroke. 1998 Mar;29(3):618–624. doi: 10.1161/01.str.29.3.618. [DOI] [PubMed] [Google Scholar]
  12. Hodkinson H. M. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972 Nov;1(4):233–238. doi: 10.1093/ageing/1.4.233. [DOI] [PubMed] [Google Scholar]
  13. House A., Dennis M., Mogridge L., Warlow C., Hawton K., Jones L. Mood disorders in the year after first stroke. Br J Psychiatry. 1991 Jan;158:83–92. doi: 10.1192/bjp.158.1.83. [DOI] [PubMed] [Google Scholar]
  14. Kotila M., Numminen H., Waltimo O., Kaste M. Depression after stroke: results of the FINNSTROKE Study. Stroke. 1998 Feb;29(2):368–372. doi: 10.1161/01.str.29.2.368. [DOI] [PubMed] [Google Scholar]
  15. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  16. MacHale S. M., O'Rourke S. J., Wardlaw J. M., Dennis M. S. Depression and its relation to lesion location after stroke. J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):371–374. doi: 10.1136/jnnp.64.3.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. O'Rourke S., MacHale S., Signorini D., Dennis M. Detecting psychiatric morbidity after stroke: comparison of the GHQ and the HAD Scale. Stroke. 1998 May;29(5):980–985. doi: 10.1161/01.str.29.5.980. [DOI] [PubMed] [Google Scholar]
  18. Pohjasvaara T., Leppävuori A., Siira I., Vataja R., Kaste M., Erkinjuntti T. Frequency and clinical determinants of poststroke depression. Stroke. 1998 Nov;29(11):2311–2317. doi: 10.1161/01.str.29.11.2311. [DOI] [PubMed] [Google Scholar]
  19. Robinson R. G., Kubos K. L., Starr L. B., Rao K., Price T. R. Mood disorders in stroke patients. Importance of location of lesion. Brain. 1984 Mar;107(Pt 1):81–93. doi: 10.1093/brain/107.1.81. [DOI] [PubMed] [Google Scholar]
  20. Schultz S. K., Castillo C. S., Kosier J. T., Robinson R. G. Generalized anxiety and depression. Assessment over 2 years after stroke. Am J Geriatr Psychiatry. 1997 Summer;5(3):229–237. doi: 10.1097/00019442-199700530-00007. [DOI] [PubMed] [Google Scholar]
  21. Singh A., Herrmann N., Black S. E. The importance of lesion location in poststroke depression: a critical review. Can J Psychiatry. 1998 Nov;43(9):921–927. doi: 10.1177/070674379804300907. [DOI] [PubMed] [Google Scholar]
  22. Wade D. T., Legh-Smith J., Hewer R. A. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry. 1987 Aug;151:200–205. doi: 10.1192/bjp.151.2.200. [DOI] [PubMed] [Google Scholar]
  23. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES