The Interplay Between Depression, Anxiety, Fatigue, and Pain in the Neurorehabilitation of Post-Stroke Patients: A Mapping Review

Introduction. Depression, anxiety, fatigue, and pain are four pathological conditions and symptoms very common in stroke patients that often occur simultaneously, affecting each other. This mutual influence seems little studied, as literature tends to study them separately.Method. This study aims to analyze the literature on the co-presence and mutual influence of anxiety, depression, fatigue, and pain in stroke patients during neurorehabilitative hospitalization. Scopus, Pubmed, Embase, and Cinahl databases were searched from 01/2017 to 12/2023.Results.  Out of the 24 included studies, 11 investigated fatigue and depression, 10 depression and pain, 6 fatigue and anxiety, and 3 anxiety and pain. In the anxiety and fatigue domains, the observational studies reported a direct association between the two variables, while the intervention studies showed the covariation over time. In anxiety and pain, all the studies reported a direct correlation. In the depression and fatigue, the observational studies showed a positive correlation of variable degree, while the RCTs didn't indicate correlations. No clear association emerged between depression and pain.Discussion. In conclusion, post-stroke pain and anxiety are less frequently assessed and addressed than fatigue and depression. Current assessment tools appear limited in their adequacy for stroke patients, highlighting important methodological gaps. Further research is needed to develop more appropriate instruments and improve psychological support and pain management in this population.