The course of anxiety symptoms in the 24 months after start of stroke rehabilitation and its relation with psychological care and unmet needs: an observational prospective cohort study

Anxiety after stroke is common and has a negative impact on quality of life but might be underdiagnosed or undertreated. To describe the course of anxiety symptoms post-stroke, and the relation with psychological care and unmet needs. In an observational prospective cohort study, patients with stroke completed the Hospital Anxiety and Depression Scale (HADS) at 3, 6, 12 and 24 months after the start of rehabilitation; 1 item about psychological care; and the Longer-Term Unmet Needs after Stroke. Chi-square and Kruskal–Wallis tests were used to compare patients within three different trajectories of anxiety symptoms based on the HADS anxiety subscale: no (all times <8), non-consistent (one to three times ≥8) or persistent anxiety symptoms (all times ≥8). Six hundred and ninety patients were included (37.7% females, median age 62 years). At 3, 6, 12 and 24 months after baseline, 136/612 (22.2%), 129/586 (22.0%), 125/548 (22.8%), and 96/487 (19.7%) patients reported anxiety symptoms, respectively. There were 248/384 (64.6%) patients with no, 97/384 (25.3%) with non-consistent, and 39/348 (10.2%) with persistent anxiety symptoms. A minority of patients with non-consistent or persistent anxiety symptoms received psychological care. They had more unmet needs and more often an unmet need related to mood. The prevalence of post-stroke anxiety remains around 20%, and in 10.2% of patients persistent anxiety symptoms were found. Optimization of screening and treatment seems of value.