Cited by 257Stroke Rehabilitation and RecoveryCardiac Health and Mental HealthCancer survivorship and care

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Anxiety after stroke: A systematic review and meta-analysis

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Rafsten, L, Danielsson, A, Sunnerhagen, K·2018·Journal of Rehabilitation Medicine

DOI 10.2340/16501977-2384

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Abstract

Anxiety is common during the first year after you have been diagnosed with stroke, with one in three experiencing it.Today anxiety after stroke gets significantly less attention compared to other psychological problems after stroke and one has reported dissatisfaction with the provision of psychological services after stroke.Since anxiety significantly influences quality of life, it is prevalent, and could be a predictor for depression.In this review, we have looked at the prevalence of anxiety at different times after stroke.We found that 29.3% of the patients had some form of anxiety disorders during the first year after stroke.The highest frequency, 36.7%, was 0-2 weeks after stroke onset.We suggest that clinicians should be more aware of anxiety that further routine screening post stroke may be worth considering providing appropriate interventions.Objective: To update the evidence surrounding the presence of anxiety after stroke.Data sources: A search was conducted in EMBASE, MEDLINE, PsycINFO, Cochrane Library, AMED and CINAHL in May 2015 and repeated in April 2017.Study selection: Clinical diagnosis of stroke and assessed for anxiety symptoms on a rating scale in the first year after stroke.Data extraction: One reviewer screened and identified studies against the inclusion criteria.A second reviewer conducted a random check of approximately 10% of titles and abstracts.Two authors independently performed the final full-text review.Data synthesis: Overall pooled prevalence of anxiety disorders was 29.3% ((95% confidence interval 24.8-33.8%),(I 2 = 97%, p < 0.00001)) during the first year.Frequency 0-2 weeks post-stroke was 36.7%, 2 weeks to 3 months 24.1%, and 3-12 months 23.8%.There was a statistically high heterogeneity in this estimate (I 2 = 97%, p < 0.00001).Conclusion: Anxiety is common during the first year post-stroke.Since anxiety significantly influences quality of life and is a predictor for depression, it may be worth considering further routine screening post-stroke.

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Mufidah, N., Suhron, M., & Wahyudi, R. (2021) · International journal of health & medical sciences · doi:10.21744/ijhms.v5n1.1807 · Cited by 17
“Patients with PSA are worried about stroke recurrence, decreased ability to work, and the risk of falling so that it can reduce their quality of life (Rafsten et al., 2018).”
Background
Influencing factors of kinesiophobia among stroke patients with hemiplegia: A mixed methods study
Chen, X., Yang, X., Li, Y., Zhang, X., Zhu, Y., Du, L., Cai, J., & Xu, X. (2024) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2024.108254 · Cited by 17
Psychometric properties of a patient‐reported outcome set in acute stroke patients
Philipp, R., Lebherz, L., Thomalla, G., Härter, M. C., Appelbohm, H., Frese, M., & Kriston, L. (2021) · Brain and Behavior · doi:10.1002/brb3.2249 · Cited by 16
“As for mental disorders, systematic reviews and metaanalyses on post-stroke anxiety (PSA) and post-stroke depression (PSD) report prevalences between 29% and 31% (Ayerbe et al., 2013; Hackett & Pickles, 2014; Rafsten et al., 2018).”
Background
Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient–partner couples after stroke
Welten, J. J. E., Cox, V. C., Kruithof, W. J., Visser‐Meily, J. M. A., Post, M. W. M., Heugten, C. M. V., & Schepers, V. P. M. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2022.2051564 · Cited by 17
“This is reflected in an increased prevalence of mood disorders in patients after stroke, both in the acute and chronic phase (Mitchell et al., 2017; Rafsten et al., 2018; Schöttke & Giabbiconi, 2015).”
BackgroundResult
Psychological Outcome after Hemorrhagic Stroke is Related to Functional Status
Ecker, S., Lord, A. S., Gurin, L. J., Olivera, A., Ishida, K., Melmed, K. R., Torres, J., Zhang, C., Frontera, J. A., & Lewis, A. K. (2022) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2022.106492 · Cited by 17
Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack
Olivé‐Gadea, M., Cano, D., Rodrigo‐Gisbert, M., Muchada, M., Montiel, E., Baladas, M., Sánchez, E., Paredes, C., García‐Tornel, Á., Rubiera, M., et al. (2022) · Stroke · doi:10.1161/strokeaha.122.040409 · Cited by 17
Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack ( PREVENT Trial): A Randomized Controlled Trial
MacKay-Lyons, M. J., Gubitz, G. J., Phillips, S. J., Giacomantonio, N., Firth, W., Thompson, K. J., Theriault, C., Wightman, H., Slipp, S., Marsters, D., et al. (2021) · Neurorehabilitation and neural repair · doi:10.1177/15459683211060345 · Cited by 17
“For them and for me”: a qualitative exploration of peer befrienders’ experiences supporting people with aphasia in the SUPERB feasibility trial
Northcott, S., Behn, N., Monnelly, K., Moss, B., Marshall, J., Thomas, S., Simpson, A., McVicker, S. J., Flood, C., Goldsmith, K., et al. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1922520 · Cited by 16
Stroke epidemiology in southern Brazil: Investigating the relationship between stroke severity, hospitalization costs, and health-related quality of life.
Tereza, D. M., Baldasso, G., Paes, R. S., de Sá, A. R., Giehl, M. W. C., & Dutra, R. (2022) · Anais da Academia Brasileira de Ciências · doi:10.1590/0001-3765202220211492 · Cited by 10
“It is estimated that approximately 20% of stroke patients experience anxiety to varying degrees after the event (Campbell Burton et al. 2013, Rafsten et al. 2018).”
Background
Comparing the effectiveness of different exercise interventions on quality of life in stroke patients: a randomized controlled network meta-analysis
Jiang, L., Ding, H., Ma, Q.-S., Gao, S., Zhang, X., & Chun, B. (2025) · BMC Neurology · doi:10.1186/s12883-025-04035-5 · Cited by 21
Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin
Atigossou, O. L. G., Ouédraogo, F., Honado, A. S., Alagnide, E., Kpadonou, T. G., & Batcho, C. S. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2083703 · Cited by 16
Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans
Ojagbemi, A., Akinyemi, J. O., Owolabi, M. O., Akinyemi, R., Arulogun, O., Gebregziabher, M., Akpa, O. M., Olaniyan, O. A., Salako, B. O., & Ovbiagele, B. I. (2020) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2020.105082 · Cited by 16
The Role of Spirituality in Stroke Survivors and Their Caregivers: A Systematic Review
Ambrosca, R., Bolgeo, T., Zeffiro, V., Alvaro, R., Vellone, E., & Pucciarelli, G. (2024) · Journal of religion and health · doi:10.1007/s10943-024-02029-0 · Cited by 17
“Although several authors tried to identify variables that could improve the stroke survivors’ and caregivers’ outcomes, such as anxiety (Rafsten et al., 2018), depression (Ezema et al., 2019), caregiver burden (Hu et al., 2018), QOL (Ramos-Lima et al., 2018) and physical functioning (Saunders et…”
Background
Exploring Psychoneurological Symptom Clusters in Acute Stroke Patients: A Latent Class Analysis
Dong, X., Yang, S., Guo, Y., Lv, P., & Liu, Y. (2022) · Journal of Pain Research · doi:10.2147/jpr.s350727 · Cited by 15
Conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation: a scoping review
Posa, S., Wasilewski, M. B., Mercer, S. W., Simpson, S., Robinson, L. R., & Simpson, R. (2022) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000542 · Cited by 17
Dyadic appraisals, dyadic coping, and mental health among couples coping with stroke: A longitudinal study protocol
Zhang, L., Zhang, Z., Mei, Y., & Liu, Q. (2020) · Journal of Advanced Nursing · doi:10.1111/jan.14495 · Cited by 15
The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study
Nerdal, V., Gjestad, E., Saltvedt, I. T., Munthe‐Kaas, R., Ihle‐Hansen, H., Ryum, T., Lydersen, S., & Grambaitė, R. (2022) · BMC Neurology · doi:10.1186/s12883-022-02756-5 · Cited by 19
Lower serum free triiodothyronine levels are associated with symptoms of depression after ischemic stroke
Taroza, S., Rastenytė, D., Burkauskas, J., Podlipskytė, A., & Mickuvienė, N. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.04.018 · Cited by 15
A qualitative study—Patient experience of tactile massage after stroke
Cronfalk, B. S., Åkesson, E., Nygren, J., Nyström, A., Strandell, A., Ruas, J. L., & von Euler, M. (2020) · Nursing Open · doi:10.1002/nop2.515 · Cited by 15
“Another recent review found anxiety to be present in one third of patients during the first 2 weeks after stroke (Rafsten et al., 2018).”
Background
Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial
González, P. B., González, R. M., Mesa, A. L., González, R. L., Mancebo‐Salas, N., Camacho‐Arroyo, M. T., Muriel, A., & García-Sastre, M. (2024) · Journal of Neurology · doi:10.1007/s00415-023-12043-z · Cited by 14
“A low level of anxiety is described as a problem or worry, and a high level of anxiety appears as panic or fear, manifesting itself physically as stress [6].”
BackgroundResultInfluential
Psychometric characteristics of the Hospital Anxiety and Depression Scale in stroke survivors of working age before and after inpatient rehabilitation
Karlsson, J., Hammarström, E., Fogelkvist, M., & Lundqvist, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306754 · Cited by 14
“By screening for mood disorders, we can identify stroke patients at risk of PSD and PSA and offer them appropriate treatment [5, 8].”
Background
Aromatherapy in Stroke Patients: Is it Time to Begin?
Contrada, M., Cerasa, A., Tonin, P., Bagetta, G., & Scuteri, D. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.749353 · Cited by 14
“3% of patients during the first-year post-stroke (Rafsten et al., 2018).”
Background
Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study
Strilciuc, Ș., Grad, D., Mixich, V., Stan, A., Buzoianu, A., Vladescu, C., & Vințan, M. (2021) · Brain Science · doi:10.3390/brainsci11060689 · Cited by 15
“Studies have shown that post-stroke patients experience a wide range of adverse outcomes, such as aphasia [2], post-stroke anxiety [3], and depression [4], among others.”
Background
Childhood ischaemic stroke in the basal ganglia can lead to fine motor and anxiety disorders: a retrospective analysis and follow-up of 109 cases
Li, T., Ma, J., Hong, S., Luo, Y., Li, X., Li, T., & Jiang, L. (2021) · BMC Neurology · doi:10.1186/s12883-021-02112-z · Cited by 13
Relationship between social capital and quality of life among adult stroke patients: a cross-sectional study in Anhui Province, China
Ji, K., Bai, Z., Zhao, Y., Sang, L., Wang, D., & Chen, R. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-022-01925-x · Cited by 13
“In addition, many patients encounter anxiety, depression, and interpersonal conflicts, which negatively influence their daily existence and quality of life (QoL) [5, 6].”
Background
Self-Perceived ADL/IADL Function is Influenced by Residual Neurological Impairment, Aphasia, and Anxiety
Juniper, A. R., & Connor, L. T. (2022) · Canadian Journal of Occupational Therapy · doi:10.1177/00084174221098876 · Cited by 13
Blocking postsynaptic density-93 binding to C-X3-C motif chemokine ligand 1 promotes microglial phenotypic transformation during acute ischemic stroke
Zhang, Q. C., Cao, X., Yang, H., Liu, X., Lou, S., Kong, L., Rong, L., Shan, J.-J., & Xu, Y. (2022) · Neural Regeneration Research · doi:10.4103/1673-5374.355759 · Cited by 13
“Furthermore, the incidence of post-stroke anxiety and depression is approximately 36.7% within 2 weeks after stroke (Pérez-Piñar et al., 2017; Rafsten et al., 2018).”
BackgroundInfluential
A cohort study on anxiety and perceived recovery 3 and 12 months after mild to moderate stroke
Nelsone, L., Rafsten, L., Abzhandadze, T., & Sunnerhagen, K. S. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1273864 · Cited by 12
“As a cutoff point, we chose ≥ 8 points for participants to have anxiety, which is consistent with other studies (9).”
BackgroundResultInfluentialSelf-citation
The effect of action modules on resilience and psychological health of stroke patients: A pilot non‐randomised control trial
Tsai, S., Li, C., Tsai, S., Kao, S., & Pai, H. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16238 · Cited by 12
Pathophysiology, Assessment, and Management of Post-Stroke Cognitive Impairment, Depression, and Fatigue
Jaywant, A., & Keenan, A. (2023) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2023.06.028 · Cited by 13
Histopathological lesions induced by stroke in the encephalon
Păun, O., Cercel, R. A., Radu, R., Raicea, V., Pîrșcoveanu, D., Honțaru, S., Zorilă, M., & Mogoantă, L. (2023) · Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie · doi:10.47162/rjme.64.3.10 · Cited by 9
“In addition to physical disabilities, patients have various mental disorders, such as mood disorders, anxiety, depression, behavioral disorders, fatigue, etc., that sometimes compromise the recovery and rehabilitation processes [11–14].”
Background
Molecular Changes in the Ischemic Brain as Non-Invasive Brain Stimulation Targets—TMS and tDCS Mechanisms, Therapeutic Challenges, and Combination Therapies
Markowska, A., & Tarnacka, B. (2024) · Biomedicines · doi:10.3390/biomedicines12071560 · Cited by 11
“Around one in three stroke survivors will develop clinically significant symptoms of depression [2], 30% will develop anxiety [3], and over 70% will suffer from cognitive deficits [4].”
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Association between depression and medication adherence in stroke survivor older adults
Srithumsuk, W., Chaleoykitti, S., Jaipong, S., Pattayakorn, P., & Podimuang, K. (2021) · Japan Journal of Nursing Science · doi:10.1111/jjns.12434 · Cited by 11
Clinical correlates of social cognition after an ischemic stroke: preliminary findings
de Souza, M. D. F. D., Cardoso, M. G. D. F., Vieira, É. L. M., Rocha, N. P., Ferreira-Vieira, T. H., Pessoa, A. E., Pedroso, V. S. P., Rachid, M. A., de Souza, L. C., Teixeira, A. L., et al. (2021) · Dementia & Neuropsychologia · doi:10.1590/1980-57642021dn15-020010 · Cited by 12
Medications adherence and associated factors among patients with stroke in the Kingdom of Saudi Arabia
Basheti, I. A., Ayasrah, S. M., Ahmad, M. M., Abu‐Snieneh, H. M., & Abuadas, F. H. A. (2022) · Pharmacy Practice · doi:10.18549/pharmpract.2022.4.2736 · Cited by 11
Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage
Chan, E., Bonifacio, G., Harrison, C., Banerjee, G., Best, J. G., Benjamin, S., Harding, N., Mas, M. D. R. H., Jäger, H. R., Cipolotti, L., et al. (2023) · Journal of Neurology · doi:10.1007/s00415-023-11977-8 · Cited by 12
“These rates are similar to those found in large-scale meta-analyses of mood disorders following stroke [41, 42].”
Result
Self-perceived postural balance correlates with postural balance and anxiety during the first year after stroke: a part of the randomized controlled GOTVED study
Rafsten, L., Danielsson, A., & Sunnerhagen, K. S. (2020) · BMC Neurology · doi:10.1186/s12883-020-01982-z · Cited by 11
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Post-stroke Anxiety Among Patients in Jordan: A Multihospital Study
Ayasrah, S. M., Ahmad, M. M., Basheti, I. A., Abu‐Snieneh, H. M., & Al‐Hamdan, Z. M. (2021) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887211060015 · Cited by 12
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Post-Stroke Rehabilitation:
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Authors: Rafsten, L., Danielsson, A., & Sunnerhagen, K.
Affiliations: Sahlgrenska University Hospital (SE)
University of Gothenburg (SE)
Corresponding author: Rafsten, L
ORCID: Rafsten, L
Danielsson, A
Sunnerhagen, K
Venue: Journal of Rehabilitation Medicine
Publisher: MJS Publishing, Medical Journals Sweden AB
Published: 2018
Volume: 50
Issue: 9
Pages: 769-778
ISSN: 1650-1977 (ISSN-L)
DOI: 10.2340/16501977-2384
OpenAlex: W2891418975
Cited by: 257
References: 58
Citations by year: 2026: 17 · 2025: 38 · 2024: 53 · 2023: 36 · 2022: 40 · 2021: 36 · 2020: 24 · 2019: 9 · 2018: 2
FWCI: 2.23
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Journal of Rehabilitation Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: anxiety, stroke, post-stroke anxiety, prevalence, anxiety disorders, depression, quality of life, psychological screening
MeSH terms: Aged, Anxiety, Humans, Middle Aged, Quality of Life, Stroke

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Anxiety after stroke: A systematic review and meta-analysis

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