Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence
Abstract
Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.
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Current evidence on the efficacy of psychological interventions for post-stroke anxiety and/or depression is limited or insufficient.
“Current systematic reviews suggest insufficient evidence for the efficacy of psychological interventions for post-stroke anxiety and/or depression.”
From Acceptance and commitment therapy (ACT) for post-stroke adjustment difficulties via telerehabilitation in a working-age man (2023) · cites this paper as Chun et al., 2022
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Investigating the shared genetic architecture between anxiety and stroke
Zhang, Y., Jiang, Y., Fan, H., Yuan, R., Jianhui, C. A. I., Zhong, B., Qin, Q., Zhang, Y., Zhang, Y., & Cheng, S. (2024) · Behavioural Brain Research · doi:10.1016/j.bbr.2024.115400 · Cited by 3 · see citing works
Barki, S., Vibha, D., Pachipala, S., Tayade, K., Misra, S., Nath, M., Singh, R., & Kumar, N. (2024) · International Journal of Psychiatry in Medicine · doi:10.1177/00912174241296233 · Cited by 2 · see citing works
“24 This variation may be due to the duration post-stroke when the scores were administered, the stroke severity and other co-interventions which may impact the scores.”
InfluentialRiyadina, W., Putri, A. S., Tuminah, S., Suswanti, I., & Turana, Y. (2024) · Asian Pacific Journal of Tropical Medicine · doi:10.4103/apjtm.apjtm_811_23 · Cited by 2 · see citing works
Xu, L., Tingting, L. I. N., Zheng, W. A. N. G., Su, S., Yu, L., Yuji, Y. U. A. N., Dong, S., Jufang, L. I., & Li, P. (2026) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000770
“Post-stroke, patients often worry about disease progression (Chun et al., 2022), leading to an FoP effect on physical health.”
Deng, Y. X., Liu, Y., Liu, J., Sang, Y., & Wang, F. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1778278 · Cited by 1 · see citing works
Lucà, F., Ceravolo, R., Gulizia, M., Gelsomino, S., Rao, C., Ingianni, N., Vitale, G., Geraci, G., Iacovoni, A., Scicchitano, P., et al. (2026) · Neurology International · doi:10.3390/neurolint18020036 · Cited by 1
“Depression and anxiety are frequent after stroke, hampering recovery and adherence to treatment [174].”
Cheng, Z., Ma, L., Zhao, M., Xu, T., Wang, J., Zhu, X., & Han, Z. (2026) · BMC Psychiatry · doi:10.1186/s12888-025-07767-3 · Cited by 1 · see citing works
“Systematic reviews indicate that over half of stroke survivors develop depression during the disease course, with cumulative incidence reaching 55% within 15 years, while 12.2% of survivors report suicidal ideation [4].”
InfluentialGSM: An Integrated GAM–SHAP–MCDA Framework for Stroke Risk Assessment
Mustapha, R., Wusu, A. S., Olabanjo, O. A., & Adetunji, B. (2025) · Analytics · doi:10.3390/analytics5010004 · Cited by 1 · see citing works
“In parallel, the heterogeneity of post-stroke outcomes has motivated trajectory-based stratification approaches, with longitudinal analyses identifying distinct post-stroke depression trajectories that highlight the importance of early and nuanced risk classification [26].”
Sleep mediates the association between stroke and all cause mortality in the NHANES cohort
Zhu, Y., & Lu, C. (2025) · Scientific Reports · doi:10.1038/s41598-025-13842-2 · Cited by 1 · see citing works
“Depression further increases the risk of death in stroke patients 59,60 .”
Farrin, A. J., Wright-Hughes, A. M., Moreau, L. A., Schofield, H., Day, F., Murden, G., Green, J., Bowen, A., Kidd, L., Bojke, C., et al. (2025) · NIHR Open Research · doi:10.3310/nihropenres.13611.1 · Cited by 1 · see citing works
Weight Management Post-Stroke: A Scoping Review
Williams, E. R., Wilson, H. K., & Gregory, C. M. (2023) · American Journal of Lifestyle Medicine · doi:10.1177/15598276231197138 · Cited by 1 · see citing works
Osstyn, S., Rauwenhoff, J., Handels, R., de Vugt, M. E., Evers, S., van Mastrigt, G. A. P. G., & van Heugten, C. M. (2025) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462324004811
Li, M., Chen, T., Wang, Y., Zhou, M., Zhou, X., 邢丽菲, Huang, H., Zhou, P., Liao, Z., Chang, Y., et al. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1785971
Sehgal, K., Sharma, C. K., Ahmad, S., Kumar, N., & Kumar, N. (2026) · International Journal of Drug Delivery Technology · doi:10.25258/ijddt.16.69s.177
“[ 15].”
Crouch, N., Hankey, G. J., Yeap, B. B., Golledge, J., Robinson, S., Etherton‐Beer, C., Flicker, L. A., & Almeida, O. P. (2026) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2026.111094
Self-citationWang, Y.-Y., Sun, W.-Z., Pan, C.-S., Zhu, Z., Li, G., Zhao, X., & Zhu, S.-Q. (2026) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s610626
“4 Given incidence rates peaking within the first six months and a cumulative prevalence of up to 52% within five years, 5–8 PSD poses a major barrier to long-term functional recovery and prognosis in stroke survivors.”
Yang, X., Han, Y., Liu, Y., Fan, H., Wang, J., He, Y., & Li, F. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1896437
“For patients after stroke, functional limitations, role changes, fear of recurrence and emotional fluctuations are common (4, 12), and the AHA scientific statement on psychosocial health after stroke highlights the high prevalence of depression, anxiety, stress, fatigue and reduced quality of life…”
MacPhee, C., Eskes, G. A., Mackinnon, S., & Champod, A. (2026) · PLoS ONE · doi:10.1371/journal.pone.0356055
“Loss of independence in everyday life can also reduce quality of life and may contribute to depression, anxiety, and fatigue [10,11].”
Outpatient rehabilitation can prevent suicide after acquired brain injury
Sörbo, A., & Björklund, R. (2026) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v58.45256
“Studies have highlighted the need for research on supporting recovery (11) and reducing suicide rates in these patients (12).”
Prelog, P. R., Zupan, M., & Frol, S. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1867538
“…(PHQ-9) item 9 or analogous items in Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression Scale (CES-D)] to dedicated suicidality questionnaires and non-standardized clinical ratings, with differing time frames and thresholds for “caseness” (2, 4, 6, 8).”
Burgio, F., Danesin, L., Corso, B., Maiorca, A., Vitale, E., & Camuccio, C. A. (2026) · NEU · doi:10.82051/neu-2026-326
“Post-stroke depression is characterized by common somatic features, like weight loss consequent to appetite decrease, lethargy, and suicidal ideation (Beblo & Driessen, 2002; Chun et al., 2022).”
Jiang, Q., Shi, G., Zhang, H., Wu, S., Liu, C., Zhang, J., Lu, E., Yuan, C., Liang, Y., Wang, L., et al. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1829901
“Age, baseline functional status, and hematoma location emerged as critical predictors of long-term recovery, consistent with previous research (13, 27–30).”
Zhu, L.-L., Han, H., Wang, H., Xie, J.-R., Cheng, X., Song, W., Huang, L., & Zhang, H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1826436
Neuroinflammation as a Key Target in the Treatment of Post-Stroke Depression
Bender, T. B., & Bykov, Y. N. (2026) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-026-02030-y
“These shifts contribute to endothelial dysfunction, hypercoagulability, increased platelet aggregation, and in fl ammatory activation, which together increase the likelihood of ischemic events [24].”
Zeng, H., Zhang, S., Zuo, T., Yang, Y., Wang, X., Luo, P., Luo, S., Zhao, W., Yang, M., Wang, L., et al. (2026) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2026.05.012
Neuroinflammation as a Key Target in the Treatment of Post-Stroke Depression
Bender, T. B., & Bykov, Y. (2026) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-026-02063-3
“These shifts contribute to endothelial dysfunction, hypercoagulability, increased platelet aggregation, and in fl ammatory activation, which together increase the likelihood of ischemic events [24].”
Chao, Y., Li, B., Xie, Z., Jia, H., & Yongchen, Z. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1648067
Mirzaahmadi, B., Shafaie, H., Mahmoodi, J., Haddadi, P., Hassanzadeh, A., Reiter, R. J., Fazli, F., Karimipour, M., & Rahbarghazi, R. (2026) · Journal of Translational Medicine · doi:10.1186/s12967-026-07709-x
“It has been shown that the occurrence of depression in IS patients is closely associated with cognitive decline and delays the recovery process, and increases socioeconomic burden [13, 14].”
NLRP3-Mediated Neuroinflammation Participates in Resilience to PSD in C57BL/6 Mice
Fu, H., Xiong, M.-Q., Xu, Q., Liu, X., Chen, X.-H., Su, Y., & Wu, Z. (2026) · Biomedicines · doi:10.3390/biomedicines14020297
“[4].”
Screening for mood disorders after stroke: feasibility of a community-based pathway
Silva, O. G., Marsden, D. L., Rajan, S., Raveendran, V., Chew, B. L. A., Hasnain, M. G., Levi, C. R., Parsons, M. W., Spratt, N. J., & Esperón, C. G. (2026) · BMJ Neurology Open · doi:10.1136/bmjno-2025-001495
Prelog, P. R., Zupan, M., & Frol, S. (2025) · Neurological Sciences · doi:10.1007/s10072-025-08665-y
“particularly in cases affecting executive control and emotion regulation [ 2, 3].”
Clark, N. E., Parkinson, B., Wang, X., Davis, B., Kidd, L., & LAWRENCE, M. (2025) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2025.102041
Yu, X.-Z., Xia, X., Guo, Y., & Wu, Y. (2025) · Journal of Stroke & Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2025.108507
Yu, L., Kong, Z.-L., & Zhao, Y.-W. (2025) · Technology and Health Care · doi:10.1177/09287329251392397
“22,23 Traditional continuous medical care model was mostly doctor-nurse model.”
Filippov, M., Pogonchenkova, I. V., Kostenko, E. V., & Shchikota, A. (2025) · Medical alphabet · doi:10.33667/2078-5631-2025-21-14-20
“…с формированием общей положительной установки на лечение, что повышает реабилитационные возможности пациента и позволяет достичь более высо - ких результатов в восстановлении поврежденных функций и избежать необоснованного назначения медикаментозной терапии [18–20 , 27 ]. e-mail: medalfavit@mail.ru”
Special Issue “Molecular Mechanisms of Neurological and Psychiatric Disease: A Decade of Progress”
Martella, G., & Montanari, M. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms262110320
“Neurological diseases, typically defined by disruptions in neuronal circuitry, are frequently accompanied by psychiatric symptoms such as depression, anxiety, and cognitive impairment [1,2].”
Hassan, E. T., Gracey, F., & Blake, J. (2025) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465825101124 · Cited by 1 · see citing works
“This 9-item tool (scoring 0 – 27) reliably detects clinically significant depression and is validated for PSD screening across diverse demographic groups with minimal somatic symptom confounding (Blake et al ., 2025; Katzan et al ., 2021).”
InfluentialRahmadhani, A., Syaripudin, A., & Romadhon, L. W. (2025) · INDOGENIUS · doi:10.56359/igj.v4i2a.722
“Stroke not only impacts physical health but also causes serious psychological problems such as anxiety, depression, and social relationship disorders (Chun et al., 2022).”
- Authors
- Chun, H.-Y. Y., Ford, A., Kutlubaev, M. A., Almeida, O. P., & Mead, G. E.
- Affiliations
- University of Edinburgh (GB)
- The University of Western Australia (AU)
- Bashkir State Medical University (RU)
- Venue
- Stroke
- Published
- 2022-04
- Volume
- 53
- Issue
- 4
- Pages
- 1402-1410
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W4200112316
- Cited by
- 150
- References
- 0
- Citations by year
- 2026: 35 · 2025: 46 · 2024: 36 · 2023: 24 · 2022: 9
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- depression, anxiety, suicide, stroke survivors, prevention, treatment
- MeSH terms
- Suicide Prevention, Anxiety, Depression, Humans, Survivors, Stroke
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