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

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 presented at the American Stroke Association’s International Stroke Conference 2025held in Los Angeles, Feb. 5–7, 2025.

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 co-author 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 co-author 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,” 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.

“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.”

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:

• 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 ages 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 a median age of 9.1 years, with an age range of 5.6 to 16.7 years.

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 presented at the American Stroke Association’s International Stroke Conference 2025held in Los Angeles, Feb. 5–7, 2025.

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 co-author 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 co-author 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,” 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.

“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.”

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:

• 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 ages 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 a median age of 9.1 years, with an age range of 5.6 to 16.7 years.