Prevalence and determinants of depression, anxiety, and stress among post-stroke patients in tertiary hospital Ghana

Abstract

In Ghana, post-stroke patients often experience a range of psychological challenges, including depression, anxiety, and stress, which hinder their recovery and quality of life. This study assessed the prevalence and determinants of depression, anxiety, and stress among post-stroke patients attending Komfo Anokye Teaching Hospital (KATH), Ghana. A health facility-based cross-sectional study was conducted among 422 post-stroke patients receiving care at Komfo Anokye Teaching Hospital. Participants were selected using consecutive sampling. Data was collected through a structured questionnaire and the Depression, Anxiety, and Stress Scale (DASS-21) to assess mental health outcomes. Data were analysed using STATA version 17.0 with descriptive statistics and multivariable logistic regression. The results showed that depressive symptoms, anxiety, and stress symptoms were reported by 67.8% (95% CI 63.3%–72.2%), 58.8% (95% CI 54.1%–63.5%), and 41.2% (95% CI 36.5%–45.9%) of patients, respectively. Furthermore, 19.4% (95% CI 15.7%–23.2%) of patients experienced depressive, anxiety, and stress symptoms simultaneously. Pairwise overlap analysis showed that 44.5% (95% CI 39.8%–49.3%) experienced both depressive and anxiety symptoms, 30.8% (95% CI 26.4%–35.2%) experienced both depressive and stress symptoms, and 27.5% (95% CI 23.3%–31.8%) experienced both anxiety and stress symptoms. Participants who engaged in physical activity were 40% less likely to experience depressive symptoms (AOR = 0.6, 95% CI 0.4–0.9, p = 0.012) than those who did not engage in physical activity. Among participants who engaged in physical activity, those who exercised daily were 80% less likely to experience depressive symptoms (AOR = 0.20, 95% CI 0.10–0.42, p < 0.001), 74% less likely to experience anxiety symptoms (AOR = 0.26, 95% CI 0.13–0.53, p < 0.001), and 77% less likely to experience stress symptoms (AOR = 0.23, 95% CI 0.11–0.48, p < 0.001) than those who exercised sometimes. Participants with diabetes were 3.1 times more likely to experience depressive symptoms (AOR = 3.1, 95% CI 1.7–5.7, p < 0.001), 2.4 times more likely to experience anxiety symptoms (AOR = 2.4, 95% CI 1.3–4.5, p = 0.006), and 2.8 times more likely to experience stress symptoms (AOR = 2.8, 95% CI 1.5–5.1, p = 0.001) than participants without diabetes. Depression, anxiety, and stress are highly prevalent among post-stroke patients and are associated with socio-demographic, clinical, psychosocial, and health system factors. Integrating routine mental health screening, psychosocial support, and accessible rehabilitation services into stroke care is essential to improve the psychological well-being and overall recovery outcomes of post-stroke patients in Ghana.