Anxiety and depression and their impact on functional recovery and quality of life in Guillain-Barré syndrome: a prospective cohort study in Bangladesh
Nowshin Papri, Ashiqa Tabassum, Tamal Saha, Gulshan Ara, Mantaka Rahman, Shahadat Hossain, M M Jalal Uddin, Md Shahanur Hossain, Liza Akter, M Tasdik Hasan, Khalid M Khan, Quazi Deen Mohammad, Zhahirul IslamObjectives
Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy manifested by progressive limb weakness. Anxiety and depression are significant yet under-recognised complications of GBS, particularly in low- and middle-income countries (LMICs). This study examined the proportion and progression of anxiety and depression in Bangladeshi GBS patients and their associations with clinical features, outcomes and quality of life (QoL).
Design
A prospective cohort study.
Settings
National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
Participants
A total of 148 GBS patients aged ≥18 years diagnosed by National Institute of Neurological Disorders and Stroke criteria for GBS, were recruited within 2 weeks of symptom onset.
Primary and secondary outcome measures
Anxiety and depression were evaluated as the primary outcome using the Hospital Anxiety and Depression Scale (HADS) at week 13 and week 26 post-GBS. Secondary outcomes included Medical Research Council sum score, GBS Disability Score, fatigue severity, pain intensity and EuroQol 5-Dimension 5-Level. Statistical analyses involved descriptive summaries, group comparisons, correlation tests and longitudinal assessments by analysis of variance.
Results
A total of 111 patients with complete HADS data were analysed (median age 36 years; 71% male). At week 13, 45% had anxiety reducing to 36% at week 26. Depression was 53% at week 13 and 41% at week 26. Baseline bulbar involvement was significantly associated with week 13 depression and week 26 anxiety. Between week 13 and week 26, 27%–30% of patients had persistent symptoms and 13%–16% experienced worsening. Anxiety and depression mostly followed concordant patterns, though 28 patients showed discordant patterns. Elevated mood symptoms were associated with greater fatigue, pain and reduced QoL.
Conclusions
Anxiety and depression are common and persistent in GBS adversely affecting recovery and QoL. Mental health monitoring and targeted support should be integrated into GBS management, especially in LMIC settings.