A new scientific statement from the American Heart Association emphasized the crucial role of nurses in managing psychosocial health issues following stroke. 

In the statement, published in Stroke, investigators highlighted the high prevalence of depression, stress, anxiety, fatigue, and reduced quality of life among stroke survivors as well as outlined evidence-based nursing interventions to address these challenges across the continuum of care.

The American Heart Association (AHA) commissioned the scientific statement to evaluate nursing care for five aspects of psychosocial health across the poststroke continuum: depression, stress, anxiety, fatigue, and quality of life. Writing group members conducted a narrative literature review using databases such as PubMed/MEDLINE, PsychInfo/EBSCOHost, PsychArticles, and the Cochrane Library, focusing on articles targeting psychological health in stroke between 2018 and 2023.

The review process involved analyzing titles, abstracts, and full-text articles for relevance, emphasizing the highest level of available quantitative evidence. The writing group identified additional research from reference lists of publications.

Among the key findings and recommendations were:

• Between 16.5% and 85% of stroke survivors experienced at least one of the addressed psychosocial constructs.
• Poststroke depression affected 24% to 29% of patients, with early-onset associated with persistent long-term disease.
• Post-traumatic stress disorder (PTSD) occurred in 16.5% of stroke patients.
• Anxiety prevalence ranged from 20% to 25% in the first months after stroke, increasing to 32% at 1 year and 34% at 5 years.
• Poststroke fatigue prevalence ranged from 25% to 85%.
• Regular screening, patient and family education, and implementation of evidence-based interventions were crucial nursing responsibilities.

The statement reported a meta-analysis showing an anytime prevalence of poststroke depression of 24% by clinical interview and 29% by rating scale. Depression was most common within 3 months, with a 1-month prevalence of 30%. Poststroke depression was associated with poor cognitive and functional outcomes, higher mortality, and poorer recovery, including shorter time to stroke recurrence. The medical expenses among patients with poststroke depression were 54% higher compared with the expenses among those who experienced stroke without depression.

A systematic review of PTSD and related symptoms in stroke patients (20 studies, n = 1,785) reported a PTSD frequency of 16.5%. Psychological stress and PTSD were found to increase stroke risk and adverse poststroke outcomes, including poststroke depression; poststroke anxiety; and poststroke reductions in medication adherence, physical functioning, and quality of life.

The frequency of anxiety ranged from 20% to 25% in the first months after stroke, increasing to 32% as the year progressed, with a 5-year prevalence of 34%. Stroke survivors residing in nonclinical settings were found to have anxiety levels nearly twice as high as those in survivors residing in hospital settings, rehabilitation facilities, or community-based centers. Anxiety was associated with poorer quality of life and restricted social participation, affecting rehabilitative outcomes.

A meta-analysis reported a poststroke fatigue prevalence of 49.5% within the first 6 weeks, with an anytime prevalence ranging from 25% to 85%. Poststroke fatigue could develop any time after stroke but most commonly presented within the first 6 months. According to epidemiological evidence, the prevalence of poststroke fatigue was highest in women, those with hemorrhagic stroke, those with a college degree, and those who were unmarried or divorced.

The statement acknowledged the difficulty in measuring quality of life after stroke because of various factors affecting daily satisfaction. It highlighted the need for validated stroke-specific quality of life assessment tools and interventions to improve quality of life outcomes. Mind-body interventions, including yoga, tai chi, and meditation were identified in multiple randomized controlled trials as positive-impact interventions on quality of life outcomes.

The statement provided detailed nursing interventions for addressing psychosocial health, including:

• Regular screening and monitoring for psychosocial symptoms
• Patient and family education on symptom recognition and management
• Ensuring appropriate pharmacological management and access to psychological interventions
• Facilitating referrals to social services and support systems
• Implementing evidence-based strategies for symptom management
• Addressing structural inequities and promoting health equity.

The investigators emphasized the need for enhanced screening with validated tools, comprehensive interdisciplinary care, and increased access to psychological and psychosocial interventions. The new statement also called for more inclusive research, particularly focusing on underrepresented populations and those with recurrent strokes or preexisting psychosocial conditions.

The statement further emphasized the need for continued assessment and evidence-based nursing care to minimize adverse psychosocial outcomes following stroke. It called for extensive and innovative nursing research spanning prevention, screening tool validation, intervention development, and testing of alternative care delivery models.

The statement highlighted the limited literature on the impact of social determinants of health, including structural racism, on psychosocial outcomes following stroke. The investigators noted that attributes of structural racism were associated with an increase in vascular risk factors, increased disease markers, poorer psychosocial health, and higher stroke mortality and risk. Those with depression coupled with low income had the greatest risk of developing a stroke.

Conflict of interest disclosures can be found in the statement.