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33 Screening for post-stroke anxiety: is there an optimum measure? A critical review of the evidence
  1. Shazia Ghamai1,2,
  2. Himanshu Tyagi1,2
  1. 1Department of Clinical and Motor Neurosciences, UCL Queen Square Institute of Neurology, London WC1N 3BG
  2. 2National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London WC1N 3BG


Introduction Post-stroke anxiety (PSA) is hugely under-diagnosed (Rafsten, Danielsson, &Sunnerhagen, 2018). As it can have a significant negative impact on both short- and long-term clinical outcomes, it is essential to have an accurate screening measure specific to stroke populations. While a considerable number of anxiety-screening instruments have been developed, there is wide variation in their applicability when used after stroke. The heterogeneity across these measures produces challenges for clinicians when selecting a reliable and valid measure for PSA.

Aim The purpose of this review is to identify tools that have been used to screen for anxiety after stroke and to systematically review their usefulness and validity in this population.

Method The literature on PSA was reviewed until 1969 using Medline (OVID version), PsychINFO and PubMed databases. Literature searches were conducted using the following keywords in multiple combinations: Post, stroke, anxiety, assessment, screening, tool, measure. Additionally, the literature search included reference lists in publications that measured anxiety in stroke populations and articles that reported the development and psychometric properties of instruments designed to measure PSA. Publications reporting measures assessing specific anxiety subtypes were excluded. All measures were reviewed individually with emphasis on the population demographic they were initially developed for, anxiety subtype they were most sensitive to, the psychometric data and advantages and disadvantages relevant to each measure.

Results A review of the articles reporting the following six measures of anxiety was conducted i.e. The Adult Manifest Anxiety Scale, the Beck Anxiety Inventory, the Behavioural Outcomes of Anxiety scale (BOA), the Geriatric Anxiety Inventory (GAI), the Hamilton Anxiety Rating Scale and the Hospital Anxiety and Depression Scale.

Preliminary data indicated that while the clinical utility of all the screening tools with regards to case-finding was tolerable, the BOA and the GAI were viewed as the most satisfactory tools for screening PSA.

Conclusions While there are several existing screening tools for anxiety, they do not show potential as suitable measures in stroke populations. Preliminary data suggests that although they are not without limitations, the GAI and the BOA serve as adequate measures of anxiety in stroke populations. Overall the literature review suggested an unmet need to develop an anxiety screening measure specifically for this population.


  1. Rafsten L, Danielsson A, Sunnerhagen KS. Anxiety after stroke: a systematic review and meta-analysis. Journal of Rehabilitation Medicine 2018;50:769–778.

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