Predictors of anxiety after stroke: a systematic review of observational studies

Background: Anxiety disorders or symptoms are relatively common following stroke. A better understanding of the predictors of anxiety in stroke patients may improve the management of these disorders. The current review was conducted to determine the predictors of anxiety following stroke. Methods: Relevant articles concerning population, hospital or rehabilitation-based studies were identified by searching 10 electronic databases up to May 2014. Methodological quality appraisal, including the validity of prognostic models and data extraction were conducted by three reviewers. Results: A total of 18 studies were identified. Data from three population-based studies including 8130 patients, 8 hospital-based studies including 1199 patients, and 7 rehabilitation-based studies including 1103 patients was evaluated. Pre-stroke depression, stroke severity, early anxiety and dementia or cognitive impairment following stroke were the main predictors of post stroke anxiety. Older age, physical disability or impairment, and use of antidepressant drugs were not associated with presence of anxiety. Limitations of studies included wide variation in screening tools and cut-off scores, variability in the time frame of screening for anxiety, use of extensive exclusion criteria and questionable statistical internal and external validity of the models. Conclusions: Lack of methodological and statistical rigour affects the validity of proposed models to predict anxiety after stroke. Future research should focus on testing proposed models on both internal and external samples to ultimately inform future clinical practice