Screening for mood disorders after stroke: feasibility of a community-based pathway

To assess the prevalence of anxiety and depression 4-6 months poststroke, examine whether demographic factors were associated with response status, and evaluate feasibility outcomes, including acceptability and utility, of a poststroke mood disorder screening programme.

This prospective cohort study included patients aged ≥18 years discharged with ischaemic stroke, transient ischaemic attack or intracerebral haemorrhage between October 2022 and February 2024 from a comprehensive stroke centre in New South Wales, Australia. Exclusion criteria were (a) current or recent patient of a multidisciplinary rehabilitation team, (b) receipt of postdischarge mental health services, (c) discharge to a residential aged care facility, (d) end-of-life care or (e) residence outside the health district. Eligible patients were mailed validated mood screening tools. High-scoring patients meeting predefined criteria were referred to a rapid-access psychiatry clinic.

Of 825 patients identified, 485 were eligible and 236 (49%) responded. Responders were older than non-responders (median 75 vs 71 years, p<0.01), and there was a trend towards fewer males (58% vs 66%, p=0.052). Among responders, 84 (35%) scored above thresholds for anxiety and/or depression. Of these, 18 (21%) were referred to psychiatry; 14 attended, and 10 (71%) received interventions, including initiation of medication and/or referral to psychology.

Anxiety and depression were highly prevalent after stroke in our population. This pilot poststroke mood disorder screening was feasible, identified one in three responders with symptoms and led to targeted psychiatric interventions in the majority of those reviewed.