Table 1.
Characteristics of included studies.
| Study (by year of publication) | ABI diagnosis | Anxiety disorder/type targeted | Eligible time since injury | Setting | Exclusion of specific deficit (e.g. speech) | Sample size | Type of intervention (I) and control (C), number randomized (n) (‘description’) |
Age (mean (SD)) |
Female (%) |
Baseline anxiety level (measure: mean (SD)) |
Time of intervention since injury (mean (SD)) |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| I | C | I | C | I | C | I | C | ||||||||
| Zhang et al. [14] | Stroke | Unspecified | Not specified | Setting not given, China | NA | 206 | Psychotherapy (n = 103) ‘Weekly sessions, each lasting 20–30 min, for 5–6 weeks, delivered by trained researcher using in-house manual’ |
Usual care (n = 103) ‘Usual care’ |
NA | NA | NA | NA | SAS I) 34(8) C) 31 (8) |
NA | NA |
| Ye et al. [13] | Stroke | ‘Mixed anxiety and depression’ | Not specified | Neurology inpatient, China | Impairment of comprehension | 90 | 1) Paroxetine (n = 31) ‘20 mg daily for 12 weeks’ 2) Imipramine (n = 32) ‘incremental regime of 50-150 mg daily for 12 weeks’ |
Routine care (n = 30) ‘Routine care: for 12 weeks' |
1) 58.04 (8.28) 2) 56.9 (11.36) |
59.21 (9.52) | 1) 26 2) 37 |
43 | HAMA 1) 18.2 (4.6) 2) 18.9 (4.4) C) 17.9 (2.24) Required diagnosis of mixed anxiety and depression on CCMD |
NA | NA |
| Wang et al. [12] | Stroke | ‘Mixed anxiety and depression’ | ‘Acute’ stroke | Neurology inpatient, China | Aphasia; severe cognitive impairment | 81 | 1) paroxetine (n = 27) ‘20 mg daily for 6 weeks’ 2) paroxetine + psychotherapy (n = 27) ‘Paroxetine 20 mg daily + weekly psychotherapy session lasting 30–60 min, delivered by psychiatrist for 6 weeks’ |
Routine care (n = 27) ‘routine stroke care’ |
1) 62.4 (6.1) 2) 64.0 (5.3) |
63.2 (5.7) | 1) 48 2) 48 |
48 | HAMA 1) 14.0 (2.8) 2) 13.9 (2.9) C) 13.8 (2.8) Required diagnosis of mixed anxiety and depression on CCMD |
1) 21.7 days (4.9) 2) 22.0 days (4.7) |
21.4 days (5.0) |
| Zhang et al. [15] | Stroke | Unspecified | Not specified | Neurology inpatient, China | NA | 94 | Buspirone butylbromide (n = 47) ‘A 2-week course of buspirone butylbromide (first week 20-30 mg/day, second week 40-60 mg per day)’ |
Routine care (n = 47) ‘Routine care’ |
57.8 (6.4) | 59.2 (5.8) | 36 | 38 | HAMA I) 22.7 (5.2) C) 22.5 (4.3) |
NA | NA |
| Wu and Liu [23] | Stroke | ‘Post-stroke neurosis’ | Not specified | Outpatient, China | Aphasia; cognitive impairment | 67 | Acupuncture (n = 34) ‘acupuncture once a day for 2 courses with 15 times as one course’ |
Alprazolam (n = 33) ‘0.4–0.8 mg 3 times a day for 4 weeks’ |
48–72 | 49–70 | 44 | 48 | HAMA I) 22.31 (3.1) C) 22.3 (3.2) Required diagnosis of post-stroke neurosis on ICD-10 |
Range: 15–53 days | Range: 15–61 days |
| Aidar et al. [16] | Ischaemic stroke | Unspecified | ≥ 1 year | Community, Portugal | Aphasia | 29 | Resistance exercise training (n = 14) ‘4 familiarization sessions + 3 pre-treatment sessions + 12 treatment sessions delivered 3 times a week, focused on walking & strength training. Duration: each session lasted 45–60 min with minimum 48-hour rest between sessions.’ |
Usual care (n = 15) ‘continue normal daily activities’ |
51.7 (8.0) | 52.5 (7.7) | 45 | 31 | STAI (data not available) | NA | NA |
| Chan et al. [17] | Stroke | Unspecified | ≥ 6 months | Community, Australia | Unable to follow 2-stage commands; unable to ambulate for 10 m or more | 17 |
Yoga and exercise (YEX) (n = 9) ‘90-minute group yoga class once per week for 6 weeks plus 24 individual 40-min home practice sessions + Exercise (EX)’ |
Exercise only (EX) (n = 8) ‘50-minute exercise class, once per week for 6 weeks’ |
67.1 (15.4) | 71.7 (12.7) | 13 | 17 | STAI-state I) 36.8 (11.6) 2) 37 (5.8) |
6.4 years (3.0) | 11.2 years (5.8) |
| Hsieh et al. [25] | Moderate-to-severe TBI | Unspecified | Not specified | Community, Australia | Language impairment | 27 | 1) Motivational interviewing (MI) + Cognitive Behavioural Therapy (CBT) (n = 9) ‘3 weekly MI sessions + 9 weekly CBT sessions’ 2) Non-directional counselling (NDC) + CBT (n = 10) ‘3 weekly NDC sessions + 9 weekly CBT sessions’ Both delivered by clinical psychologist or clinical neuropsychologist |
Usual care and waitlist (n = 8) ‘offered CBT after waitlist period’ |
1) 41.8 (15.2) 2) 36.4 (14.1) |
35.6 (9.8) | 1) 22 2) 30 |
13 | HADS-A 1) 11.9 (3.3) 2) 13.0 (5.0) C) 11.8 (4.3) DSM-IV TR anxiety disorder or adjustment issues required |
1) 37.2 months (45.4) 2) 50.4 months (89.7) |
23.0 months (18.5) |
| Mikami et al. [21] | Stroke | Generalized anxiety disorder (GAD) | Within 3 months | Community, USA | Severe comprehension deficits | 149 | 1) Escitalopram (n = 47) ‘5 or 10 mg per day for 12 months’ 2) Problem solving therapy (PST) (n = 53) ‘manual-based, 6 treatment sessions (weeks 1, 2, 3, 4, 6 and 10), plus 6 reinforcement sessions (months 4, 5, 6, 8, 10 and 12)’ |
Placebo (n = 49) ‘Placebo pills’ |
1) 61.5 (13.7) 2) 68.3 (10.4) |
64.8 (13.5) | 1) 36 2) 45 |
33 | HAMA 1) 7.1 (5.6) 2) 8.3 (5.4) C) 6.8 (4.4) Excluded DSM-IV TR GAD diagnosis |
NA | NA |
| Hoffmann et al. [20] | Stroke | Unspecified | Not specified | Stroke unit inpatient & community, Australia | Communication difficulties/cognitive impairment | 33 | 1) Coping skills (n = 11) ‘cognitive and behavioural exercises, delivered by clinical psychologist’ 2) Self-management (n = 12) ‘Information provision and activities to learn problem solving skills, delivered by occupational therapist’ |
Usual care (n = 10) ‘multidisciplinary care on stroke unit’ Both interventions 1) and 2) consist of 8 one-hour face-to-face sessions, with first 2 sessions delivered pre-discharge, and remaining sessions at patient's home |
1) 63.6 (13.0) 2) 60.8 (11.7) |
57.0 (14.2) | 1)36 2) 25 |
40 | HADS-A 1) 5.3 (2.9) 2) 5.7 (0.5) C) 8.4 (3.1) |
NA | NA |
| Cullen et al. [24] | Stroke; moderate-severe TBI | ‘Emotional distress—anxiety and/or depression’ | 3–36 months | Outpatient clinic, UK | Significant communication impairments | 27 | Brief positive psychotherapy (n = 14) ‘One-to-one weekly sessions with psychologist for 8 weeks—Psychoeducation about ABI and positive psychology (Week 1), therapeutic exercises and homework (Weeks 2–7), midpoint review at (Week4), final review and plan for maintenance (Week 8)’ |
Usual care (n = 13) ‘Within clinical service’ |
Median 54.0 (IQR 46.0–59.0) | median 58.0 (IQR 56.0–68.0) | 36 | 39 | DASS-21 anxiety I) 17.6 (9.7) C) 21.1 (9.4) Had to score moderate-to-above on at least depression or anxiety subscale on DASS-21 |
Median: 5.8 months (IQR 3.5–8.2) | Median: 5.6 months (IQR 3.1–8.4) |
| Golding et al. [19] | Stroke | Unspecified | Not specified | Community, UK | Unable to complete telephone questionnaire | 21 | I: relaxation CD ‘self-help autogenic relaxation CD, five times per week for a month with diarly sheets; each session 20-min in length, instructions on body awareness’ |
Waitlist | 67.8 (7.5) | 62.4 (8.4) | 40 | 50 | HADS-A I) 10.9 (3.4) C) 10.5 (3.5) Had to score at least 6 on HADS-A |
118 months (101) | 70 months (70) |
| Chun et al. [18] | Stroke | Unspecified | At least 1 year after stroke onset | Community, Korea | Severe cognitive or communication impairment | 59 | I: Forest therapy ‘4-day and 3-night program at recreational forest area, consisting of 1) promoting positive emotion through mediation, 2) experiencing the forest through all five sense and 3) walking in the forest’ |
Urban group ‘stay in a hotel, with similar mediation and walking activities in the urban area’ |
62.1 (8.3) | 59.5 (9.7) | 37 | 28 | STAI I) 38.1 (11.0) C) 34.3 (12.1) |
140 months (90) | 153 months (84) |
| Simblett et al. [22] | Stroke | ‘Emotional distress—anxiety and/or depression’ | Within 5 years | Community, UK | Impairment of comprehension; visual or auditory problem that would interfere participation and could not be corrected | 28 | Computerised cognitive behavioural therapy (cCBT) (n = 19) ‘An 8-module online course-‘Beating the Blues', one module per week for 8 consecutive weeks’ |
Computerised Cognitive remediation therapy (cCRT) (n = 9) ‘An 8-module online course-‘ForamenRehab’, one module per week for 8 consecutive weeks’ |
62.1 (11.4) | 64.6 (8.1) | 47 | 11 | BAI I) 11.2 (7.6) C) 8.3 (6.2) Required ‘emotional distress’: BDI > 13 or BAI > 7 |
Median: 1.19 years (IQR 0.5–1.1) | Median: 0.89 years (IQR 0.6–4.1) |
| Both the intervention and active control are delivered via computer, facilitated by a researcher via telephone/email/face-to-face | |||||||||||||||
I indicates intervention; C, control; n, number; SD, standard deviation; IQR, interquartile range; NA, data not available; DASS, Depression Anxiety Stress Scales; DSM-IV, Diagnostic Statistical Manual of Mental Disorders, fourth edition; BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; CCMD, Chinese Classification of Mental Disorders, third version; HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Rating Scale for Depression; SAS, Zung Self-Rating Anxiety Scale. STAI, State Trait Anxiety Inventory.