Emotional outcomes after stroke: factors associated with poor outcome
- aNeurosciences Trials Unit, Department of Clinical Neurosciences, The University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, UK, bLiaison Psychiatry
- Dr Martin Dennis, Neurosciences Trials Unit, Dept of Clinical Neurosciences, The University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, UK email
- Received 29 March 1999
- Revised 2 August 1999
- Accepted 16 August 1999
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.