Stroke survivors experiencing depression or anxiety are more likely to recover from their psychological symptoms if they engage in talking therapy, according to a new large-scale study conducted by researchers at University College London (UCL).
This landmark study, published in Nature Mental Health, is the first of its kind to investigate outcomes for stroke survivors who accessed NHS Talking Therapies for Anxiety and Depression. Researchers analysed data from all 1.9 million adults who attended the service in England between 2012 and 2019, including 7,597 individuals who had previously experienced a stroke.
Mental health conditions such as depression and anxiety are common after stroke, with over one in three survivors affected. Without appropriate intervention, these symptoms can hinder recovery, both cognitively and physically, and have been linked to increased mortality—previous studies suggest that stroke survivors with depression face a 20–50% greater risk of death in the years following their stroke compared to those without.
However, the UCL study found that the NHS Talking Therapies service—offering free cognitive behavioural therapy (CBT), counselling, and guided self-help—is an effective option for stroke survivors. Among those who completed treatment, 71% showed reliable improvement, meaning their change in symptoms was substantial enough to be unlikely due to chance. Moreover, nearly half (49%) achieved full, reliable recovery from their depression and anxiety symptoms. These figures closely match the UK Government’s recovery target of 50% for the general population, despite the broader understanding that individuals with long-term physical conditions tend to have poorer outcomes in psychological services.
The therapies were delivered in varied formats, including one-on-one sessions, group work, and online options. Depression was assessed using the PHQ-9 questionnaire, which tracks mood-related symptoms such as loss of interest, sleep difficulties, and persistent sadness. Anxiety was measured using the GAD-7 tool, focusing on feelings of worry, restlessness, and tension.
Overall, the findings revealed moderate reductions in depression and functional impairment for stroke survivors—functional issues being defined as challenges in work, home management, social relationships, and leisure activities. Anxiety levels, however, saw an even greater degree of improvement. The timing of therapy emerged as a critical factor: those who began treatment within six months of their stroke were significantly more likely to achieve reliable recovery compared to those who started therapy a year or more after the event. These outcomes held even when adjusted for age, gender, area-based socioeconomic deprivation, and baseline symptom severity.
Lead researcher Dr Jae Won Suh of UCL Psychology & Language Sciences commented: “Our findings strongly reinforce previous small-scale studies indicating that talking therapies are effective in addressing post-stroke depression and anxiety. Furthermore, we found that early intervention makes a notable difference. It is vital that GPs and other healthcare professionals actively screen stroke survivors for mental health symptoms and facilitate prompt referrals to psychological services.”
While the results are promising, the study also highlighted specific disparities. Compared to the general population, stroke survivors undergoing talking therapy were overall less likely to achieve reliable recovery and somewhat more likely to experience symptom deterioration. Yet, once the analysis controlled for other co-existing physical health problems—more prevalent among stroke survivors—these differences largely disappeared.
Co-author Professor Joshua Stott added that this finding points to a need for adaptation within the mental health care system. “Our results suggest that clinicians providing psychological therapies should receive enhanced training to meet the complex needs of individuals with long-term physical conditions,” he explained. “This includes addressing cognitive impairments, sensory deficits, and overlapping medical challenges. By investing in such specialised training, we can significantly improve mental and physical health outcomes for thousands of patients.”
This study underscores the importance of integrating mental health care into the broader rehabilitation pathway for stroke survivors, and it calls attention to the potential for talking therapies to play a central role in recovery. The research offers a strong case for early intervention and for equipping mental health professionals with the tools and training needed to effectively treat those managing both psychological distress and the long-term effects of a significant physical health event.
More information: Jae Won Suh et al, A record-linkage study of post-stroke primary care psychological therapy effectiveness in England, Nature Mental Health. DOI: 10.1038/s44220-025-00429-z
Journal information: Nature Mental Health Provided by University College London
