Stroke may increase risk of anxiety, depression and more in children

(Press-News.org) Research Highlights:

Children who have had a stroke may be at higher risk for developing anxiety, depression and related physical symptoms such as headaches and stomach aches than their peers. Among the study participants, the most common age for emotional challenges in young stroke survivors was around age 9. Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal. Embargoed until 4 a.m. CT/5 a.m. ET, Thursday, Jan. 30, 2025

DALLAS, Jan. 30, 2025 — Stroke may increase the risk of developing anxiety, depression and related physical symptoms such as headaches and stomach aches in children, especially in 8- and 9-year-olds, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting, in Los Angeles, Feb. 5-7, 2025, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

The researchers noted that this link between anxiety and depression in children who have had an ischemic stroke (stroke caused by blood vessel blockage, the most common type of stroke) is not well understood.

“Our analysis found that mental health challenges are present at a higher rate in these young stroke survivors compared to the general population,” said study coauthor Nomazulu Dlamini, M.D., Ph.D., M.Sc., director of the Children’s Stroke Program and a staff neurologist at the Hospital for Sick Children in Toronto, Canada. “For kids, we know that psychological symptoms are often underrecognized. 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.”

Researchers at The Hospital for Sick Children in Toronto conducted a retrospective analysis (looking back in time) of 161 school-age children who had suffered an ischemic stroke between 2002 and 2020. These children were enrolled in the hospital stroke registry and followed until adulthood. Between the ages of 5 and 17, the children completed the Behavior Assessment System for Children questionnaire, which screens for depression, anxiety and chronic stomach aches and minor pains – also known as somatization. Scores for depression, anxiety and somatization in children were determined and then compared with children in the general population.

The analysis found:

Depression, anxiety and somatization were found in 13%, 13.7% and 17.4% of childhood stroke survivors, respectively. The median age for mental disorders occurred between 8.5 and 9.6 years old, representing the age of greatest vulnerability for children who had a stroke. Average scores for mood, anxiety and somatization were higher in stroke survivors than in the general pediatric population. Children who showed signs of somatization were older than age 2 at the time of stroke onset. The researchers noted that kids who have a stroke may face mental health issues that can be just as challenging as the physical effects of their stroke.

“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 coauthor Jennifer Crosbie, Ph.D., a psychologist at The Hospital for Sick Children.

“These children are discharged after recovering from their stroke, but parents report significant mental health impairments. This study highlights the risk of mental health difficulties over time. There is this lurking anxiety after children are discharged,” Crosbie said. “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.”

“I was not surprised that mental health disorders — particularly anxiety and depression — are especially common in childhood stroke survivors. 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. The implications are that health care professionals should proactively screen for mental health disorders in all survivors of childhood stroke older than 2 years of age. They should also be aware of the more subtle manifestations of anxiety in young children and include that in their counseling,” said Heather J. Fullerton, M.D., M.A.S., co-chair of the American Heart Association 2019 Scientific Statement Management of Stroke in Neonates and Children and professor of Neurology & Pediatrics; Kenneth Rainin Chair of Pediatric Stroke Care; chief, Division of Child Neurology and medical director at the Pediatric Brain Center at UCSF Benioff Children’s Hospitals in San Francisco, California. Fullerton was not involved in this study.

The main study limitations are that it took place at a single site and that the scores used for mental health outcomes are based solely on questionnaires, not clinical assessments.

Study details, background or design:

The study conducted at The Hospital for Sick Children in Toronto, Canada, included a total of 161 patients (between 0 and 13.8 years old, 98 boys and 63 girls) who suffered an ischemic stroke. Children who had an ischemic stroke between 2002 and 2020 were added to the hospital’s stroke registry. Assessments for depression, anxiety and somatization were completed by the children (between age 5.6 and 16.7 years) as part of a standardized protocol. Median age of stroke was 1.9 years. The children were assessed with neuropsychological measures at median age of 9.1 years, with an age range of 5.6 to 16.7 years. Co-authors, disclosures and funding sources are listed in the manuscript.  

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

Multimedia is available on the right column of the release link Link to poster abstract TMP90; and ASA International Stroke Conference 2025 Online Program Planner ASA Information: Stroke in Children AHA news release: Survey of CVD programs finds more resources needed for heart disease and stroke risk in youth (Aug. 2023) AHA news release: How to prioritize healthy behaviors to support kids’ physical and mental health (May 2020) AHA health initiative: title of initiative with hyperlink For more news at ASA International Stroke Conference 2025, follow us on X @HeartNews #ISC25 ###

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, X.

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