The consideration of time since stroke on intervention outcomes for post-stroke depression and anxiety: A systematic review

This systematic review aimed to synthesize evidence from randomized controlled trials (RCTs) to explore the impact of time since stroke on post-stroke mood intervention outcomes. Four databases were searched from inception to November 2025. RCTs that involved psychological interventions for managing depression or anxiety in adult stroke survivors, with an active or passive control group, were included. Risk of bias was assessed and a narrative synthesis conducted. Fourteen publications were included in this review at data extraction. Due to time since stroke reporting limitations, synthesis was split by maximum time since stroke recruitment of less than three months, six months, and over six months post-stroke. A higher proportion of studies conducted at an earlier time since stroke reported significant improvement in depression following the intervention compared to controls. Only four studies included anxiety as an outcome. The results provide preliminary indication that interventions were more frequently effective when provided earlier in the recovery timeline; however, extreme caution is required with interpretation due to high heterogeneity and low-quality research. Future RCTs on interventions for post-stroke mood should routinely report time since stroke, consider directly investigating the impact of time since stroke on intervention outcomes, and use other methods to synthesize existing research.