Children Who Experience a Stroke Have a Greater Anxiety Risk

Nomazulu Dlamini, MD, PhD, MSc

Credit: Hospital for Sick Children

Children who have had a stroke, especially at the end of primary school, may be at a greater risk for developing anxiety, a preliminary study found.¹ Findings will be presented at the American Stroke Association International Stroke Conference 2025 from February 5 – 7, 2025.

Pediatric arterial ischemic stroke can lead to mental health conditions, such as depression and anxiety. In a retrospective analysis of a prospective single-center cohort of school-aged children who suffered from arterial ischemic stroke, investigators sought to determine the scale of mental health issues among this pediatric population. The team also wanted to educate clinicians about the mental health risks in children who had survived a stroke.

“For kids, we know that psychological symptoms are often underrecognized,” said study coauthor Nomazulu Dlamini, MD, PhD, MSc, director of the Children’s Stroke Program and a staff neurologist at the Hospital for Sick Children in Toronto, Canada, in a press release.² “We wanted to understand which children are more at risk of developing mental health problems and identify the clues that would allow us to offer interventions that support better mental health and improve their quality of life.”

Children were enrolled in the single-center cohort between 2002 and 2020 and were followed until adulthood.¹ Investigators compared the prevalence and levels of depression and anxiety, evaluated with version 1 and 3 of the Behavior Assessment System for Children (BASC), for children who did and did experience an arterial ischemic stroke. The team also measured for somatization, an internalizing subscale in the BASC questionnaire.

The study included 161 children (98 males) who survived an arterial ischemic stroke between the years 0 – 13.8 years (mean age at stroke, 1.9 years). Children had neuropsychological measures assessed at a median age of 9.1 years (range: 5.6 – 16.7 years).

In total, 13%, 13.7%, and 14.8% of school-age children with arterial ischemic stroke reached clinical scores of ≥ 70 for depression, anxiety, and somatization, respectively, with median scores of 81.0 for depression, 76.6 for anxiety, and 81.9 for somatization subscales. The median age of children with depression, anxiety, or somatization ranged from 8.5 and 9.6 years.

“I was not surprised that mental health disorders — particularly anxiety and depression — are especially common in childhood stroke survivors,” said Heather J. Fullerton, MD, co-chair of the American Heart Association and medical director at the Pediatric Brain Center at UCSF Benioff Children’s Hospitals in San Francisco, in a statement.² “What was novel and surprising was the high prevalence of somatization (anxiety manifesting in stomach aches and minor pains) in young children. I think this issue is under-recognized.”

Children who survived an arterial ischemic stroke had greater mean scores for mood, anxiety, and somatization compared with the general pediatric population. Within the somatization clinical group, the age at stroke was above 2 years old (P = .034).¹

“So many gains have been made in the management of the physical and medical outcomes in this population that now we are starting to see the long-term effects on mental health,” said study co-author Jennifer Crosbie, PhD, a psychologist at The Hospital for Sick Children, in a statement.² “There is this lurking anxiety after children are discharged. Our objective is to make parents aware that this is a risk factor so they can advocate for their children, because the earlier the intervention, the better the outcome. If we know that certain populations are at higher risk, health care professionals can establish a standard check-in during follow-up care, ensuring no child with these conditions is left to struggle alone.”

References

1. ^{Hidden Challenges: Mental Health Outcomes in Pediatric Stroke Survivors. Poster presented at American Stroke Association International Stroke Conference 2025 from February 5 – 7, 2025 in Los Angeles.}
2. ^{Stroke may increase risk of anxiety, depression and more in children. EurekAlert! January 30, 2025. https://www.eurekalert.org/news-releases/1071533. Accessed February 4, 2025.}