General Practitioners’ Knowledge and Perspectives on Post-Stroke Depression, Anxiety, Apathy, and Fatigue: A Cross-Sectional Survey Study

Background: Post-stroke neuropsychiatric symptoms are common but frequently overlooked in clinical practice. General practitioners (GPs) who maintain long-term patient relationships are well placed to identify these symptoms. Aims: To assess GPs’ knowledge, beliefs, and confidence in diagnosing and managing post-stroke neuropsychiatric symptoms, and to explore their management strategies as well as perceived barriers. Methods: A survey was distributed to GPs practising in the Republic of Ireland in June 2024. Quantitative data was analysed descriptively and inferentially, and free-text responses underwent conventional content analysis. Results: Of the 292 respondents, the majority (85%) viewed that post-stroke neuropsychiatric symptoms are underdiagnosed. Nearly two-thirds viewed themselves as the healthcare professionals most responsible for diagnosing and managing these symptoms. Despite this, the proportions who were very/extremely confident in diagnosing and managing these symptoms were low: depression (27%), anxiety (26%), apathy (15%), and fatigue (15%). The proportion who often/always screened for these conditions was low, with post-stroke depression (45%), and anxiety (34%) being screened more often than fatigue (23%) and apathy (17%) Some of the strongest perceived barriers to effective diagnosis and management included other post-stroke complications being higher priority, insufficient time during consultations, insufficient hospital discharge information, and post-stroke cognitive impairment. Conclusions: GPs perceive post-stroke neuropsychiatric symptoms as frequently missed, highlighting a critical opportunity for earlier recognition in primary care. Enhanced support and resources are required to improve assessment and management. These findings can guide targeted resource allocation to address barriers in providing mental health care to stroke survivors.