Generalized Anxiety Disorder in Stroke Patients: A 3-Year Longitudinal Study
Abstract
Background and Purpose This prospective study examined the prevalence and longitudinal course of generalized anxiety disorder (GAD) after stroke and its comorbidity with major depression over time. The contributions of lesion characteristics, functional impairment, and psychosocial factors to the development of GAD after stroke were studied. Methods In a population-based cohort of 80 patients with acute stroke, we assessed GAD and comorbid major depression, functional ability, and social network at regular time points over 3 years. Cerebral atrophy and brain lesion parameters were determined from CT scans performed at the acute stage and after 3 years. Results The prevalence of GAD after stroke was 28% in the acute stage, and there was no significant decrease through the 3 years of follow-up. At 1 year, only 23% of the patients with early GAD (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of a chronic development of the anxiety disorder. Comorbidity with major depression was high and seemed to impair the prognosis of depression. At the acute stage after stroke, GAD plus depression was associated with left hemispheric lesion, whereas anxiety alone was associated with right hemispheric lesion. Cerebral atrophy was associated with both depression and anxiety disorder late but not early after stroke. Dependence in activities of daily living and reduced social network were associated with GAD at all follow-up periods except at the acute stage. Conclusions GAD after stroke is a common and long-lasting affliction that interferes substantially with social life and functional recovery. There is a differentiation of factors implicated in its development based on the period of time since the stroke event.
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ACT's emphasis on acceptance of distress and getting on with life is suited to stroke because physical effects such as hemiplegia are enduring and psychological effects such as anxiety may persist for many years.
“Its emphasis on acceptance of distress and 'getting on with life' is suited to stroke because, in many people, physical effects such as hemiplegia are enduring and even psychological effects such as anxiety may persist for many years (Astrom, 1996).”
From Brief group‐based acceptance and commitment therapy for stroke survivors. (2019) · cites this paper as Astrom, 1996
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“[3,4] Late-life GAD is associated with decreased quality of life,[5,6] cognitive impairment,[7,8] increased health care utilization,[5] and poorer recovery after disabling medical events.[5,9] Elderly GAD subjects have a three-fold increase in risk of health-related activity limitation, compared to nonanxious elderly,…”
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- Authors
- Åström, M.
- Affiliations
- From the Department of Psychiatry, University Hospital, Umeå, Sweden.
- Venue
- Stroke
- Published
- 1996-02
- Volume
- 27
- Issue
- 2
- Pages
- 270-275
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2134369317
- Cited by
- 329
- References
- 0
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 11 · 2020: 14 · 2019: 7 · 2018: 5 · 2017: 13 · 2016: 19 · 2015: 15 · 2014: 19 · 2013: 14 · 2012: 24
- FWCI
- 7.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- generalized anxiety disorder, major depressive disorder, comorbidities, hemispheric lateralization, brain atrophy, activities of daily living, social networks, functional recovery, prevalence, longitudinal course
- MeSH terms
- Activities of Daily Living, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Cerebrovascular Disorders, Cross-Sectional Studies, Depressive Disorder, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Morbidity, Prospective Studies, Risk Factors, Social Behavior, Time Factors, Prevalence
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