Risk Factors for Anxiety or Depression in Patients With Stroke During the Acute and Recovery Phases: An Independent Cohort Study

Abstract

Background: To identify the overall risk factors for any clinically significant anxiety or depressive anxiety or depression in patients with stroke in the acute and recovery phase cohorts, compare the differences in overall risk factors between two independent patient cohorts at different disease stages, so as to provide a reliable basis for early screening and staged intervention of post-stroke emotional anxiety or depression.

Methods: This is a retrospective study that included 252 stroke patients admitted to Nantong Rici Hospital Affiliated to Yangzhou University from August 2023 to October 2025, which were divided into two independent cohorts: the acute phase cohort (7–14 days after onset, n = 143) and the recovery phase cohort (3 months after onset, n = 109), all eligible patients were assigned to either the anxiety or depression group or the non-anxiety or depression group according to the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and 24-item Hamilton Depression Rating Scale (HAMD-24). Following univariate analysisbased screening of potential risk factors, the significantly different indicators were further included in the multivariate Logistic regression model to identify independent determinants and clarify differences across stages.

Results: In the acute phase cohort, the incidence of anxiety or depression was 30.07% (43/143), and the independent risk factors identified were age [odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.10–1.38], illiterate educational level (OR = 8.15, 95% CI: 2.28–29.12), no dedicated care (OR = 5.52, 95% CI: 1.58–19.34), hemorrhagic stroke (OR = 6.39, 95% CI: 1.61–25.30), multiple lesions (OR = 5.07, 95% CI: 1.31–19.66), National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.25, 95% CI: 1.03–1.52), and combined atrial fibrillation (AF) (OR = 5.38, 95% CI: 1.20–24.09) (p all < 0.05). In the recovery phase cohort, the incidence of anxiety or depression was 25.69% (28/109), and the independent risk factorsidentified were age (OR = 1.21, 95% CI: 1.05–1.39), combined diabetes mellitus (DM) (OR = 4.63, 95% CI: 1.18–18.20), AF (OR = 3.94, 95% CI: 1.07–14.45), and coronary heart disease (CHD) (OR = 5.86, 95% CI: 1.45–23.73) (p all < 0.05). Age and combined AF were the common independent risk factors in both cohorts.

Conclusions: There are differences in the risk factors for anxiety/depression between independent stroke patients cohorts at different disease stages. Clinically, individualized intervention should be carried out according to the key risk factors of each disease stage to reduce the risk of anxiety or depression.