Talking therapy boosts recovery in stroke survivors with depression or anxiety

Stroke survivors with depression or anxiety who attend talking therapy sessions are more likely to recover from their psychological symptoms, finds a new study by UCL researchers.

The first of its kind study, published in Nature Mental Health, analysed data from all 1.9 million patients who attended NHS Talking Therapies for Anxiety and Depression services in England between 2012 and 2019, including 7,597 stroke survivors.

More than one in three stroke survivors experience depression or anxiety. Without appropriate mental health treatment, recovery – both physical and cognitive – can be slower, and previous studies have shown that the risk of death may increase by 20-50% in the years following a stroke in those with depression compared to those without.

However, the researchers found that NHS Talking Therapies for Anxiety and Depression are an effective treatment for stroke survivors, as 71% experienced reliable improvement (i.e. a large enough change in symptoms that it is very unlikely to be due to chance) and 49% reliably recovered from depression and anxiety following treatment in the services.

This is in line with the UK Government target for the general population that 50% of people who complete treatment in the services should recover – despite it being known that, in general, people with long-term physical health conditions have worse treatment outcomes than average in NHS Talking Therapies.

NHS Talking Therapies for Anxiety and Depression is a free NHS service and offers CBT, counselling and guided self-help, with sessions delivered either face-to-face individually, in groups or online. 

In the study, depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9), which considers factors such as a lack of interest in doing things, issues with sleep, and feelings of low mood.

Symptoms of anxiety were measured using the GAD-7 questionnaire, which asks how often a person feels worried, on edge or unable to relax.

On average, stroke survivors who attended talking therapies experienced a moderate reduction in depression and functional impairment symptoms (such as the ability to work, manage a home, form and maintain close relationships, and partake in leisure activities), and large reductions in anxiety symptoms.

Additionally, the timing of accessing talking therapy after a stroke also affected its effectiveness.

Patients who started attending talking therapies a year or more after a stroke were less likely to reliably recover than those seen within six months of a stroke, regardless of differences in characteristics such as age, gender, area deprivation, and baseline symptom scores.

Our findings strongly support existing evidence from small studies that talking therapies effectively treat depression and anxiety after a stroke. 

We also found that the sooner stroke survivors begin talking therapy, the better the outcomes. It is essential for general practitioners and other clinicians working with stroke survivors to screen for depression and anxiety symptoms and refer patients for psychological therapy as early as possible."

Dr. Jae Won Suh, Lead Author, UCL Psychology & Language Sciences

Nevertheless, the study also showed that, stroke survivors who had talking therapy were less likely to reliably recover and more likely to reliably deteriorate when compared to otherwise similar people without a stroke, but no significant differences remained (in their talking therapy outcomes) after controlling for the level of other physical health problems (which people with stroke are more likely to have).

Consequently, the researchers believe talking therapies may need to be further adapted to ensure maximum impact for stroke survivors.

Co-author Professor Joshua Stott (UCL Psychology & Language Sciences) explained: "The worse outcomes for stroke survivors compared to those who had not had a stroke suggest the importance of mental health clinicians receiving more training on treating people with long term conditions, including those with cognitive impairments, sensory loss, and complex physical health issues.

"Investing in such training will improve both mental and physical health outcomes for thousands of patients."

The research was funded by the Alzheimer's Society.