Cardiovascular

Risk Factors for Anxiety or Depression in Patients With Stroke During the Acute and Recovery Phases: An Independent Cohort Study.

TL;DR

Risk factors for post-stroke anxiety or depression differ between acute and recovery phases, with age and combined atrial fibrillation being common independent risk factors in both cohorts, supporting the need for individualized staged interventions.

Key Findings

The incidence of anxiety or depression in stroke patients during the acute phase (7-14 days after onset) was 30.07%.

  • 43 out of 143 patients in the acute phase cohort met criteria for anxiety or depression.
  • Diagnosis was based on the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and 24-item Hamilton Depression Rating Scale (HAMD-24).
  • The acute phase cohort included patients admitted from August 2023 to October 2025 at Nantong Rici Hospital Affiliated to Yangzhou University.
  • Patients were classified into anxiety or depression group versus non-anxiety or depression group.

The incidence of anxiety or depression in stroke patients during the recovery phase (3 months after onset) was 25.69%.

  • 28 out of 109 patients in the recovery phase cohort met criteria for anxiety or depression.
  • The recovery phase cohort was an independent cohort assessed at 3 months after stroke onset.
  • The same diagnostic instruments (HAMA-14 and HAMD-24) were used as in the acute phase cohort.

Seven independent risk factors for anxiety or depression were identified in the acute phase cohort.

  • Age (OR = 1.23, 95% CI: 1.10-1.38), illiterate educational level (OR = 8.15, 95% CI: 2.28-29.12), no dedicated care (OR = 5.52, 95% CI: 1.58-19.34), hemorrhagic stroke (OR = 6.39, 95% CI: 1.61-25.30), multiple lesions (OR = 5.07, 95% CI: 1.31-19.66), NIHSS score (OR = 1.25, 95% CI: 1.03-1.52), and combined atrial fibrillation (OR = 5.38, 95% CI: 1.20-24.09).
  • All p-values were < 0.05.
  • Risk factors were identified using multivariate logistic regression following univariate analysis-based screening.
  • Illiterate educational level had the highest odds ratio among all acute phase risk factors (OR = 8.15).

Four independent risk factors for anxiety or depression were identified in the recovery phase cohort.

  • Age (OR = 1.21, 95% CI: 1.05-1.39), combined diabetes mellitus (OR = 4.63, 95% CI: 1.18-18.20), atrial fibrillation (OR = 3.94, 95% CI: 1.07-14.45), and coronary heart disease (OR = 5.86, 95% CI: 1.45-23.73).
  • All p-values were < 0.05.
  • Coronary heart disease had the highest odds ratio among recovery phase risk factors (OR = 5.86).
  • The recovery phase risk factor profile shifted toward comorbid cardiovascular and metabolic conditions compared to acute phase factors.

Age and combined atrial fibrillation were the only common independent risk factors present in both the acute and recovery phase cohorts.

  • Age OR in acute phase: 1.23 (95% CI: 1.10-1.38); age OR in recovery phase: 1.21 (95% CI: 1.05-1.39).
  • Atrial fibrillation OR in acute phase: 5.38 (95% CI: 1.20-24.09); AF OR in recovery phase: 3.94 (95% CI: 1.07-14.45).
  • All other risk factors were stage-specific, with acute phase factors including stroke type and lesion characteristics while recovery phase factors included metabolic and cardiac comorbidities.

Risk factors specific to the acute phase included stroke-related clinical characteristics, while recovery phase risk factors were dominated by pre-existing comorbidities.

  • Acute phase-specific factors included hemorrhagic stroke type, multiple lesions, NIHSS score, illiterate educational level, and lack of dedicated care.
  • Recovery phase-specific factors included diabetes mellitus and coronary heart disease.
  • This pattern suggests that early post-stroke mood disorders are more influenced by stroke severity and social support, while later mood disorders are more influenced by chronic disease burden.
  • The study used two independent cohorts rather than a single longitudinal cohort, representing separate patient groups at different disease stages.

The study was a retrospective cohort study of 252 stroke patients divided into two independent cohorts based on disease stage.

  • Total sample: 252 stroke patients admitted from August 2023 to October 2025.
  • Acute phase cohort: n = 143 (assessed 7-14 days after onset); recovery phase cohort: n = 109 (assessed 3 months after onset).
  • Study site: Nantong Rici Hospital Affiliated to Yangzhou University.
  • Analytical approach: univariate screening followed by multivariate logistic regression to identify independent determinants.

What This Means

This research examined what factors increase the risk of anxiety or depression in stroke patients at two different points in their recovery: the acute phase (1-2 weeks after stroke) and the recovery phase (3 months after stroke). The study followed 252 stroke patients and found that about 30% developed anxiety or depression in the early acute phase, while about 26% did so by the 3-month recovery phase. Importantly, the factors that predicted emotional distress were quite different depending on the stage of illness. In the early weeks after stroke, patients were more likely to develop anxiety or depression if they were older, had lower education levels, lacked dedicated caregiving support, had a hemorrhagic (bleeding-type) stroke, had multiple brain lesions, had more severe stroke symptoms (as measured by a standard neurological scale), or had atrial fibrillation (an irregular heart rhythm). By the 3-month recovery phase, however, the picture shifted: the risk factors that mattered most were older age, atrial fibrillation, diabetes, and coronary heart disease. Only age and atrial fibrillation were consistently important at both time points. This research suggests that screening and prevention programs for post-stroke emotional disorders should be tailored to the specific stage of recovery. In the acute period, interventions might focus on patients with severe strokes, limited social support, or lower education, whereas at 3 months, attention should shift toward patients with multiple cardiovascular and metabolic conditions. The findings highlight that a one-size-fits-all approach to identifying at-risk patients may miss important stage-specific warning signs.

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Citation

Li M, Ge C, Han Y, Tang Y, Zhao L. (2026). Risk Factors for Anxiety or Depression in Patients With Stroke During the Acute and Recovery Phases: An Independent Cohort Study.. Actas espanolas de psiquiatria. https://doi.org/10.62641/aep.v54i4.2286