title: Effect on anxiety and depression of a multifactorial risk factor intervention program after stroke and TIA: a randomized controlled trial.
abstract: OBJECTIVE
  Depression and anxiety related to stroke are caused by vascular lesions and psychological reactions. Treatment of vascular and modifiable behavioral risk factors reduces the risk of stroke and may also reduce the risk of emotional changes after stroke. We aimed to investigate whether a multifactorial risk factor intervention program in patients with first-ever stroke or transient ischemic attack (TIA) can influence post-stroke anxiety and depressive symptoms in patients one year post-stroke.
  
  
  METHODS
  The study population consisted of first-ever stroke and TIA patients allocated in a randomized, evaluator-blinded, controlled trial to care as usual or a structured and multidisciplinary follow-up including intensive treatment of vascular risk. The primary endpoint (cognition) has previously been reported. The secondary endpoint, reported here, was changes in the Hospital Anxiety and Depression Scale (HADS) from baseline to 12-month follow-up.
  
  
  RESULTS
  One hundred and ninety-five patients were randomized. The estimated difference between treatment groups, in changes in HADS, from baseline to 12 months was -1.32 (95% confidence interval: -2.61, -0.04; P = 0.044) in favor of the intervention group. One year post-stroke, 4/85 (4.7%) patients in the intervention group and 12/89 (13.5%) in the control group suffered from depression (P = 0.045), while 7/85 (8.2%) patients in the intervention group and 13/89 (14.6%) patients in the control group suffered from anxiety (P = 0.19).
  
  
  CONCLUSIONS
  A structured, multidisciplinary, multifactorial risk factor program including vascular risk factor management may be associated with reduced HADS scores and a lower prevalence of depressive symptoms one year after stroke.
authors: a Department of Internal Medicine , Bærum Hospital, Vestre Viken , Bærum , Norway.
authors: Hege
authors: H
authors: Ihle-Hansen
authors: Bente
authors: B
authors: Thommessen
authors: Morten Wang
authors: MW
authors: Fagerland
authors: Anne Rita
authors: AR
authors: Oksengård
authors: Torgeir Bruun
authors: TB
authors: Wyller
authors: Knut
authors: K
authors: Engedal
authors: Brynjar
authors: B
authors: Fure
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation / Q000628:therapy; D008297:Male; D010348:Patient Care Team; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000523:psychology* / Q000628:therapy; D000071939:Stroke Rehabilitation
keywords: anxiety; anxiety and trauma related disorders; depression; mood disorders; psychosocial interventions; training and educational programs