A record-linkage study of post-stroke primary care psychological therapy effectiveness in England.

At least one-third of stroke survivors are affected by depression or anxiety, but no large-scale studies of real-world clinical practice have assessed whether psychological therapies are beneficial for these patients. Here we show that psychological treatment is effective for stroke survivors on average, using national healthcare records from National Health Service Talking Therapies services in England, including 7,597 patients with a hospital diagnosis of stroke before attendance. Following psychological treatment, stroke survivors experienced moderate reductions in depression and large reductions in anxiety symptoms. Patients who started attending the services a year or more after a stroke were less likely to reliably recover from symptoms of depression or anxiety than those seen within six months of a stroke, irrespective of differences in baseline characteristics including age, gender, local area deprivation and symptom severity. Compared with a matched sample of patients without a stroke, stroke survivors were less likely to reliably recover and more likely to reliably deteriorate after psychological treatment, although adjusting for level of physical comorbidity attenuated these relationships. It is crucial that clinicians working with stroke survivors screen for symptoms of depression and anxiety and consider referring patients to primary care psychological therapies as early as possible.