Mood disturbance is very common after stroke. It may present as low mood, depression or anxiety, or with increased levels of emotional agitation, instability or emotionalism, limiting functional recovery and often associated with risk assessment needs and increased mortality (Morris et al, 1993; House et al, 2001). Many people with stroke are troubled by psychological distress that does not meet diagnostic criteria for depression and anxiety but which nevertheless disrupts and impedes their lives and relationships. A stroke is a significant life event and in this context some emotional distress is normal and part of adjustment to a substantial change in circumstances. Healthcare professionals working with people with stroke should be aware that mood disturbance after stroke can arise because of psychosocial factors (e.g. disability, loss, trauma), or as a result of neurochemical changes in the brain, or both. [2023]
Depression affects about one third of people with stroke and frequently persists long-term (Hackett et al, 2009; Ayerbe et al, 2014). Anxiety is also common, affecting around one-quarter of people with stroke, and, like depression, may only become evident after several months (Knapp et al, 2020). Depression and anxiety are closely linked and may be part of a single emotional response to stroke, commonly alongside additional psychological effects such as hopelessness, frustration or anger. [2023]
In a UK survey, three-quarters of people with stroke reported experiencing at least one mental health problem after a stroke, with 44% of people reporting experiencing anxiety or depression, 42% experiencing mood swings, 47% experiencing reduced self-confidence and 16% reporting suicidal thoughts (Stroke Association, 2020). A survey of long-term needs found that nearly three-quarters of people with emotional difficulties felt their needs had not been fully met (McKevitt et al, 2011). [2023]
Psychological disturbances also commonly follow on from neuropsychological consequences of stroke, whether such underlying effects are recognised or hidden. This highlights the need for sufficient and adequate assessment to correctly identify what may underpin and explain emotional changes after stroke and thereby guide appropriate rehabilitation approaches. Additionally, mood disturbance or other mental health issues may frequently exist for people prior to a stroke, which will affect their post-stroke experience (Taylor-Rowan et al, 2019), and need to be considered and understood for their clinical management and rehabilitation planning. [2023]
As far as is possible, approaches and assessment measures should be adapted for use with people with mild aphasia, and several have been designed specifically for people with more severe aphasia (e.g. the Stroke Aphasic Depression Questionnaire [SADQ], the Depression Intensity Scale Circles [DISCs] or the Behavioural Outcomes of Anxiety [BOA] scale). [2016]