Association of in-hospital depression and anxiety symptoms following stroke with 3 months- depression, anxiety and functional outcome

Background: Post-stroke depression and anxiety are common and are associated with worse post-stroke outcomes. Even though checking for depression during stroke hospitalization has become a common practice, the prognostic value of a positive in-hospital depression screen following stroke remains unclear. Methods: This is a retrospective cohort study of patients with stroke or TIA discharged home from a tertiary care center. We examined the association between premorbid history of depression and in-hospital anxiety/depressive symptoms, with anxiety/depressive symptoms and functional outcome at 3-months post-stroke. Logistic regression models were generated using two different main predictors: 1) pre-hospital history of depression (N = 117) and 2) in-hospital depression/anxiety measured by the EQ-5D-3L (N = 66). Results: In the cohort of 117 patients, the mean age was 66 years, with median NIHSS 2;44% were women and 70% White. A history of pre-stroke depression was reported by 7% (8/117). Anxiety/depression on ED-5D-3L was reported by 29/66 (43%) in the hospital and by 22/66 (33%) at three months' post-stroke. In the first adjusted model, previous history of depression was associated with 3 months EQ-5D-3L anxiety/depression (OR = 10.2;95%CI:1.12-90.9, p = 0.038). In the second adjusted model, in-hospital anxiety/depression was associated with 3-month EQ-5D-3L anxiety/depression (OR = 3.9; 95% CI:1.16-13.1, p = 0.027). In-hospital anxiety/depression was associated with a higher mRS at 3 months but not after adjusting for covariates. Conclusion: A previous history of depression and in-hospital anxiety/depression symptoms are associated with anxiety/depression symptoms 3-months post-stroke but not with functional outcome. Screening stroke patients for both during hospitalization is warranted because of the association with later symptoms.