Impact of Anxiety on Health-Related Quality of Life After Stroke: A Cross-Sectional Study

Objective: To examine the impact of anxiety on health-related quality of life (HRQOL) of stroke survivors. Design: Cross-sectional study. Setting: Acute stroke unit in a regional hospital. Participants: Patients (N=374) from an acute stroke unit. Interventions: Not applicable. Main Outcome Measures: The presence of anxiety was defined as a score of >= 8 on the anxiety subscale of the Hospital Anxiety Depression Scale. HRQOL was measured by the total score and 12 domain scores of the Stroke Specific Quality of Life (SSQOL) scale. Demographic characteristics and history of medical conditions were also recorded. Clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale, Barthel Index, Mini-Mental State Examination, and Geriatric Depression Scale (GDS). Results: Eighty-six (23%) stroke survivors had anxiety. The anxiety group had significantly more women (62.8% vs 35.1%), higher GDS scores (7.5 +/- 4.5 vs 3.5 +/- 3.6), and lower scores for total SSQOL (3.9 +/- 0.6 vs 4.5 +/- 0.6) and SSQOL domains of energy (2.0 +/- 1.2 vs 3.4 +/- 1.4); mood (3.6 +/- 1.5 vs 4.6 +/- 0.9), personality (3.4 +/- 1.7 vs 4.4 +/- 1.1), and thinking (2.4 +/- 1.2 vs 3.5 +/- 1.4), after adjustment for sex and GDS score. In subsequent multivariate regression analysis, the Hospital Anxiety Depression Scale anxiety score was negatively associated with the SSQOL total score (r=-.154) and 5 of the 12 domain scores, namely energy (r=-.29), mood (r=-.102), personality (r=-.195), thinking (r=-.136), and work/productivity (r=-.096). Conclusions: Anxiety has a negative effect on HRQOL of stroke survivors, independent from depression. Interventions for anxiety should improve stroke survivors' quality of life. Archives of Physical Medicine and Rehabilitation 2013;94:2535-41 (C) 2013 by the American Congress of Rehabilitation Medicine