Abstract Body: Introduction:
The burden of disease from pediatric arterial ischemic stroke (AIS) includes non-visible disability in the form of mental health conditions such as depression and anxiety which impact the quality of life of children and families affected by stroke.
Objectives: To determine the scale of the mental health phenomenon in the pediatric AIS population in a large single-center study, and to educate clinicians about this significant risk in pediatric stroke survivors.
Methods:
A retrospective analysis of a prospective single-center cohort of school-aged children diagnosed with AIS, enrolled between 2002 and 2020 was conducted. Depression and anxiety were evaluated with the Behavior Assessment System for Children (BASC, versions 1 and 3). Prevalence and scores for depression and anxiety were ascertained children with AIS and compared with general pediatric population scores. Somatization, a third internalizing subscale in the BASC questionnaire, was also included in the analysis.
Results:
AIS patients (N=161, 98 male; median age and range at stroke 1.9 years [0 – 13.8 years]) were assessed with neuropsychological measures at median age and range 9.1 years (5.6 – 16.7 years). Clinical scores for depression, anxiety and somatization, i.e., T= ≥ 70 in the Depression (mean = 81.0, SD= 8.7), Anxiety (mean= 76.6, SD=8.3) and Somatization (mean= 81.9, SD= 11.0) subscales, were found in 13%, 13.7% and 17.4% of school-age children with AIS respectively, with the median age ranging between 8.5 and 9.6 years,representing the age of greatest vulnerability in our cohort. In AIS patients, mean scores for mood, anxiety and somatization were higher compared to the general pediatric population. Age at stroke in the children within the Somatization Clinical group were older than 2 years age at time of stroke(p=0.034).
Conclusions:
Mental health disorders represent a significant problem in pediatric stroke survivors, with the end of primary school appearing to be the time of greatest vulnerability. These mental health outcomes, (depression, anxiety, somatization) could be associated with age at stroke. The symptoms manifested due to these mental health challenges are frequently overlooked. Therefore, early detection and intervention are essential to change patient trajectories and improve outcomes and quality of life.