Anxiety after stroke: prevalence, intervention effectiveness, and illness representations

Stroke is a life changing event that can result in significant negative consequences. As such psychological disturbances may arise. In the general population anxiety is the most prevalent mental health condition, yet it remains under-researched and under-recognised
within stroke survivors. Anxiety, is associated with decreased quality of life, increased healthcare utilisation, and increased severity of depression. The aims of the programme of research organised in this thesis were to establish a quantitative estimate of the prevalence
of anxiety after stroke, to determine if there were any interventions that were effective in treating it and to uncover psychological factors that may have attributed to the manifestation of anxiety after stroke.

Three studies were conducted. The first was a systematic review and meta-analysis of observational studies that assessed the prevalence of anxiety after stroke. The second
study was a Cochrane systematic review of randomised control trials to examine if any interventions were effective in treating anxiety after stroke. The third study was a longitudinal cohort study that used the common-sense model of illness representations (Leventhal, Meyer and Nerenz 1980) to uncover the illness beliefs held by stroke survivors, and to evaluate whether these beliefs were associated with anxiety after stroke.

Approximately 20% of stroke survivors were found to have an anxiety disorder, and 25% experienced significant levels of anxiety symptoms. Currently, there is insufficient
evidence from randomised control trials to guide treatment of anxiety after stroke. Illness representations were relatively stable over time. Only higher illness identity (e.g. attributing a higher symptom burden to stroke), and having a more emotional response to ones stroke
were associated with anxiety in stroke survivors.

Several limitations in all three studies may restrict the generalisability and validity of the findings and there are many questions that remain unanswered. However this work has
contributed substantially to the investigation into the phenomenon of anxiety after stroke and can inform clinical guideline development, post-stroke psychological service provision and future intervention studies.